Denham Manor is registered to provide care to 53 people who live with dementia or who are older people. On the day of our inspection there were 38 people living in the home.

The service had a registered manager. 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 the beginning of our inspection we found the home manager had sent in their application to be the registered manager for the service. The home manager had an interview with our registration inspector during our inspection. On the last day of our visit we received confirmation from our registration team that the home manager's application had been approved.

At our previous inspection in November 2014, we rated the service overall, ‘requires improvement’. We found a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was a lack of proper information about people by means of inaccurate records and documentation of care.

During this visit we found records in relation to people’s care and other documents were accurate, up to date and regularly reviewed.

People and their relatives spoke positively about the care provided. Comments included, “All the staff provided consistent care” and “I have been here for four to five months. My son who is 73 and my daughter, visit me every week. I am happy. It is good here. I have my nails polished. Don’t they look good?”

Caring relationships were formed with staff and the people they provided care and support to. Staff understood the care needs of the people they cared for. People were supported to exercise choice and where possible encouraged to be independent.

People said they felt safe from abuse which was also supported by their relatives. Comments included, “I feel safe here day and night. The night staff say that they check me every 2 hours (A review of the person’s daily record chart confirmed this)” and “I will tell them (management) if they (staff) hurt me. “

People benefitted from a safe service where staff understood their safeguarding responsibilities. This was because staff recognised signs of potential abuse and knew how to raise safeguarding concerns and received the relevant training. There were sufficient staff to meet people’s care, treatment and support needs and staff were deployed in a way that kept people safe. Risk management plans were in place to promote people’s safety and to maintain their independence.

People and their relatives said staff were skilled to carry out their duties and due to this felt confident with the care and support received. Comments included, “They (staff) seem to be (skilled and experienced)” and “They (staff) appear to be skilled and caring.” Staff received appropriate induction, training and supervision. People's rights were protected because staff understood the issues of consent, mental capacity and Deprivation of Liberty Safeguards (DoLS).

The service introduced plans of care that reflected what people or their legal representatives said they wanted. People had a range of activities they could be involved in and were able to choose what activities they took part in. People and their relatives said they knew how to raise concerns and their concerns were responded to satisfactorily.

People and their relatives gave positive responses in regards to how the service was managed. Comments included, “(Name of manager) is spot on. They check to make sure everything is fine. She is very professional” and “I believe it’s a well-led service. Staff felt confident to raise any concerns in relation to poor work practices (this is commonly referred to as whistle blowing). The service had systems in place to drive continuous improvemen

We met with four people who lived in the home. We read their care files. We discussed their care and treatment. One person who was leaving the home to go home told us “I could really settle down here…my mind was a mess when I arrived, but it is sorted now.”

People told us how staff asked their permission before carrying out care and support, and how the care and treatment was of a good standard. One person told us “There are no problems here.” We did observe one staff member caring for a person without verbal interaction. This meant that the person may not have been aware of what was going on around them and did not show respect to the person.

We discussed with six staff how the home was run. Staff told us that the manager was effective. They felt that the home was well run, but there were things they could improve on such as record keeping. We found care plans were generally well written, but there were some omissions relating to checks of people’s care.

We saw documentation relating to support for staff was in place, however the manager may wish to note that whilst there was evidence in the records we saw that supervision and training was available, not all staff reported frequent supervision was happening.

We saw records relating to complaints. We saw how the manager had responded appropriately and in a timely way to complaints. We were told by staff how they would respond to complaints in a way that did not discriminate against the complainant.

This inspection took place on the 10 and 11 November 2014. At the last inspection on11 May 2014, we asked the provider to take action to make improvements to the management of people’s care and welfare, supporting staff and how they assessed and monitored the quality of service provision, and this action has been completed.

Denham manor is registered to provide care to 53 people who live with dementia or who are older people. On the day of our inspection there were 31 people living in the home. The home was undergoing refurbishment of people’s bedrooms and bathrooms.

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.

Systems were in place to record the care provided. These included charts to record when people were moved to prevent pressure sores, consumed food and drink and had general care and attendance. Some people’s charts had not been completed. The forms were used to monitor the care given, without this information monitoring was not possible.

Extensive refurbishment of the home was underway; the registered manager had considered the risks to everyone entering the building. They had systems in place to protect people from harm whilst the refurbishments were taking place. Although people told us they felt safe living in the home we found some areas presented hazards to people. The provider had failed to restrict access to these areas. This placed people at risk of harm.

People told us the food they received in the home was good. However we observed a lack of staff available to support people with their food at lunchtime. This meant some people became upset and frustrated. We have made a recommendation about the management of staff at mealtimes.

We saw there were sufficient numbers of staff available at other times of the day and night to support people. Systems and checks were in place to ensure staff were safe to work with the people in the home. Staff were supported to carry out their role through induction training, supervision and appraisals. We observed staff and their interactions with people. They were caring and attentive, people responded well to this. Not all staff felt supported by the registered manager which made them reluctant to raise concerns or complaints.

Medicines were stored and administered safely. People’s health was monitored and when required staff acted quickly to refer them to other professionals to maintain their health.

The home was following the Mental Capacity Act (MCA) and making sure that the human rights of people who lacked mental capacity to take particular decisions were protected.

Care plans recorded people’s assessments of their needs, and how care was to be delivered to them. Risks associated with their care had been identified and documented. People told us they were happy with the way their care was delivered and staff took notice of their preferences.

The provider displayed a copy of the complaints procedure in the home, and people received a copy. Discussions took place in meetings to remind people how to make complaints or raise concerns. Where complaints had been made, the registered manager or the provider had responded appropriately. People were given the opportunity to feedback their views of the service through meetings, questionnaires and discussions with staff. The provider acted upon this information to improve the service.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which

corresponds to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

 You can see what action we told the provider to take at the back of the full version of the report.