The inspection took place on12 and 13 December 2017.

Diamond House provides accommodation; support and care for up to 42 older people, some of are living with dementia. People in care homes receive accommodation and personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Although the service is registered to provide nursing care, this is not provided as the service is not staffed to provide nursing care. At the time of our inspection 35 people were using the service and one was in hospital.

There was 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 who used the service and relatives were happy with the care provided and many praised the skills and kindness of the staff.

People received safe care but at times staffing was stretched which meant people living with dementia were left without staff supervision. The shortage of activities staff meant that some people were not meaningfully occupied during the day which had an impact on their quality of life. The manager had strategies in place to try and address the staffing concerns.

Medicines were mostly well managed and people received their prescribed medicines on time. Some stocktaking errors meant we could not be fully assured that all medicines were being given as prescribed. The provider had already identified this as an issue and was taking action to address the issue.

The manager assessed and managed risks well. People were supported to be as independent as possible and any associated risks were incorporated into their care plan.

Staff understood their responsibilities with regard to keeping people safe from the risk of abuse. Staff were confident and knew how to raise concerns. Individual safeguarding incidents were well managed and the provider was open and transparent when carrying out safeguarding investigations.

Infection control procedures were in place and staff demonstrated a good knowledge of how to reduce the risk and spread of infection.

Staff were well trained and supported in their roles. Sone staff had received specific training related to eating and drinking and this was managed very well.

People had good and prompt access to healthcare and staff worked well with other healthcare professionals to meet people’s healthcare needs.

The service worked in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not have the capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

Staff were kind and caring and demonstrated that they had built up good relationships with the people they were supporting and caring for. People were supported to be as involved in decisions about their care as they wished to be.

People who used the service had the opportunity to follow a variety of hobbies and interests, although it was hoped that this would improve further when new activity staff were recruited.

New care plans were person centred and reflected people’s individual need and preferences. People confirmed that their wishes with regard to their care, were respected.

Care for people at the end of their life was good. There was a commitment to ensuring people ha

The inspection took place on 5 April 2016 and was unannounced.

The home was registered to provide accommodation with personal care for up to 42 older people. There are 38 single rooms and two double rooms which were not used as multi-occupied rooms. On the day of our visit there were 39 people living at the home, some of whom were living with dementia.

There was a registered manager at the service, who was permanently based onsite. 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 felt safe living at the home. Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm of it they needed to report any suspected abuse.

Systems were in place to identify risks and protect people from harm. Risk assessments were in place and regularly reviewed. Where someone was identified at being at risk actions were identified on how to reduce the risk and referrals were made to relevant health care professionals.

There were sufficient staff numbers on duty to keep people safe and to meet people’s needs. Safe staff recruitment procedures were in place which ensured only those staff suitable to the role were in post.

Policies and procedures were in place to provide staff with the safe ordering, administration, storage and disposal of medicines. Medicines were managed, stored, given to people as prescribed and disposed of safely by trained staff.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the MCA and DoLS. Staff sought consent from people regarding their care. Appropriate referrals where in place, along with best interest decision meetings and consent from relatives where appropriate for people assessed as lacking capacity to make specific decisions.

Staff were worked well with people living with a dementia and had received appropriate training to deal with all elements of providing care services.

People health care needs were assessed, monitored and recorded and referrals for assessment and treatment were made. Where people had appointments within healthcare they were supported by staff to attend these.

Staff were caring, knew people well, and supported people in a dignified and respectful way. Staff acknowledged people's privacy. People felt that staff were understanding of their needs and provided support during periods of distress. Staff had positive working relationships with people.

Care was provided to people based on their individual needs and was person-centred. People and their relatives were fully involved in the assessment of their needs and in care planning to meet those needs. Staff had a good knowledge of people's changing needs and action was taken to review care needs.

Staff listened and acted on what people said and there were opportunities for people to contribute to how the service was organised. People knew how to raise any concerns. The views of people, relatives, health and social care professionals were sought as part a quality assurance process.

Quality assurance systems were in place to regularly review the quality of the service that was provided.

This particular service was taken over in January 2016 by Larchwood Care.

We carried out this inspection in response to concerns that we received around the safety of people who used the service and due to the amount of notifications we received concerning allegations of abuse.

Care records included detailed assessments of the person's identified health needs and associated risks. We observed appropriate care provided to people which was confirmed in people's care plans.

There was detailed guidance in place for staff to follow to raise any concerns around the safety of people. Staff we spoke with explained the different types of abuse and told us what they would do if they saw or heard abuse.

During our inspection visit on 03 April 2013, we observed positive interaction between staff and people using the service whilst respecting their values and human rights. One person told us, "You can do what you want; nobody makes you do anything you don't want to."

We looked at four out of 35 people's care records and saw that associated risks were identified, such as personal care, nutrition, mobility and pressure area, and these were monitored and reviewed on a monthly basis.

People were provided with a choice of suitable and nutritious food and drink. We saw menu cards displayed in both dining areas which offered a varied choice for breakfast, dinner and evening meals.

The provider had a robust system to manage medication safely and there was a policy in place for staff to follow. We found that medication was administered by staff that understood the process and had been trained to administer medication safely.

We spoke to staff members who told us they were happy working at Diamond House and felt supported by their managers and were able to discuss matters at any time.

We found that the provider had various systems in place to monitor the quality of the service provided to people. People were able to express their views about their care and assured that they would be acted on if appropriate.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service, and a practising professional.

During our inspection of Diamond House on 11 July 2012 we used a number of different methods to help us understand the experience of people living in the home. This was because some people were living with dementia, which meant that they were not able to tell us their experiences. For part of the inspection 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 with us.

People who spoke with us were happy with the choices being provided at Diamond House. One person told us, “We can do what we like, when we like”. When we asked about the food, one person told us, “It’s good, home-cooked food, and plenty of it”, and another said, “If you don’t like the choice you can always ask for something else”. People also told us that the staff were, “Very kind” and, “Would do anything for you”. Another person said it was, “The kindness of the staff that makes it pleasant (at the home)”. People told us they felt safe at the home and that their concerns would be listened to.

However, our observations during our inspection showed that people were not always treated with respect, and their dignity and independence were not always maintained. People were not always offered sufficient food and drinks to ensure they were well nourished and well hydrated, and some people were not given adequate support to eat and drink.