About the service: Ditton Priors Care Centre is registered to provide accommodation with personal care for up to 23 older people, who may be living with dementia. There were 20 people living at the home at the time of our visit, one person was in hospital. Care is provided across two floors and communal areas were located on the ground floor. Not all bedrooms were ensuite.

People’s experience of using this service:

• People told us that they were happy and contented living at Ditton Priors Care Centre.

• Risk assessments managed risks within people’s lives and staff knew how to keep people safe from known risks.

• People received their medicines as prescribed from trained and competent staff.

•There were sufficient numbers of care staff on duty to keep people safe and to monitor the communal areas of the home. However, at times, staffing levels went below assessed levels but people told us this did not adversely affect them.

• Staff felt well-prepared for their role because they had training in relevant subjects and were supported to develop their skills.

• Staff understood their safeguarding responsibilities.

• People were supported to have 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’s dietary needs, preferences and nutritional needs were assessed and known by staff.

• People were referred to other professionals to support their healthcare needs.

• Staff were kind, respectful and responsive towards people. They understood people’s concerns and were quick to offer reassurance which reduced people’s anxiety.

• Staff knew people well and supported people in line with their care plan. Care plan records were reviewed but in some cases, needed more detailed information for staff to provide the person centred care, staff told us about.

• Improvements to provide people with opportunities to engage in activities and interests had increased people’s stimulation since our last inspection visit.

• Following the last inspection visit, the registered manager and regional managers had changed and the instability of management had affected some aspects of the service. The provider had appointed a registered manager who was open and honest to us about the challenges they faced within the service.

• The provider’s quality assurance processes had not always identified when audits were not completed.

• The registered manager was visible and approachable. Staff said changes were for the better and they worked well as a team.

• The registered manager had plans to further improve upon the changes already made and time for those to embed would demonstrate their true effectiveness. The registered manager was working with other organisations and healthcare professionals to improve outcomes for people.

We found the service met the characteristics of a “Good” rating in four areas and “Requires Improvement” in one area; For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: Good. The last report for Ditton Priors Care Centre was published on 25 August 2016.

Why we inspected: This was a planned inspection based on the rating at the last inspection. The previous ‘good’ service provided to people continued, however a number of changes within the management of the service and provider, affected some aspects of this service. However, the overall rating continues to be Good.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection was unannounced and took place on 15 June 2016.

Ditton Priors Care Centre provides accommodation and personal care for up to 23 older people and people living with dementia. On the day of our inspection 14 people were living there.

At the previous inspection on 6 and 7 May January 2015, we asked the provider to take action to make improvements with the management of medicines and to ensure that their governance promote good care. The provider sent us an action plan to tell us what they would do to address the breach of regulations. At this inspection we found that this action had been completed. It is the condition of this provider’s registration that they have a registered manager in post but there has not been one in post since May 2016. The provider had appointed a manager prior to the registered manager leaving their post to ensure that people and the staff team received continued support. The manager told us they were in the process of submitting an application to register with the Care Quality Commission. 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 a 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 in the home and staff knew how to protect them from the risk of potential abuse. Staff were aware of the risk posed to people and took action to avoid this happening. People's care and treatment needs were met because there were enough staff on duty to care for them. People were supported by staff to take their medicines as prescribed to maintain their health.

People were cared for by staff who were trained and had received regular one to one [supervision] sessions from the management team. People’s human rights were protected because staff were aware of the principles of the Mental Capacity Act 2005. People were supported by staff to eat and drink sufficient amounts and were assisted to access relevant healthcare services when needed.

People were cared for by staff who were aware of their care needs and this was delivered in a kind and sympathetic manner. People were encouraged to be involved in planning their care. Staff were aware of the importance promoting people’s right to privacy and dignity.

People were encouraged to be involved in their assessment and to pursue their interests. Staff recognised the support people required to maintain their independence and this was promoted. Staff knew when people were unhappy and action was taken to address this.

People were encouraged to have say in how the how was run. The provider had taken action to improve their governance so people received a better service. Staff felt supported in their role by the management team to provide a more effective service for people.

A single inspector carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People who were able to told us they felt safe living at Ditton Priors Care Centre. Other people appeared relaxed and comfortable in the company of the staff and the other people they shared their home with. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The home was not clean and hygienic in several areas and the home is required to take action to improve in this area. You can see what we have asked them to take at the back of this report.

Is the service effective?

People's health and care needs were assessed and people and their representatives were involved in reviewing their care and support. Specialist equipment needs had been identified in care plans where required.

It was clear from our observations and from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well.

Staff told us they received effective support from their managers and said they were approachable and operated an 'open door' policy.

Is the service caring?

People were supported by staff who demonstrated a clear understanding of their needs. We saw that care workers showed patience and gave encouragement when supporting people. People told us, "I am alright here. The staff are nice, they look after me well".

People's preferences and interests had been recorded and care and support had been provided in accordance with people's wishes. We saw people were treated with respect and dignity by the staff on duty.

Is the service responsive?

We saw the home had been responsive to people's changing needs. The home worked with other agencies and services to make sure people received their care in a joined up way. Staff had developed close and positive working relationships with health and social care professionals such as the district nurse and doctor. This ensured they worked in people's best interests and were able to continue to meet people's changing needs.

We saw people enjoying carrying out tasks to help the staff. These included dusting and clearing away cups.

Is the service well-led?

The service had a quality assurance system in place although it had not identified the shortfalls in the cleanliness of the home.

Staff were clear about their roles and responsibilities. They told us the management team operated an open door policy and always welcomed their suggestions for improvement. They told us they felt listened to.

They considered the service was well-led. They said they received regular opportunities to meet on an individual and group basis and felt supported in their work.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents. This reduced the risks to people and helped the service to continually improve. Risks to people had been identified, assessed and kept under regular review.

We spoke with five people who were living at the home. They were all mostly happy with the service they received. Their comments included, “It’s marvellous”, “A lovely place to be” and, “It’s a nice place”.

People were generally complimentary about the staff. Two people said that some of the staff could occasionally be, “Short” or, “Grumpy” with them at busy times.

We found that the manager used a variety of ways to consult people about the service they received. People told us that their opinions were listened to and respected.

We saw that care plans were person centred, comprehensive and up to date. People’s needs were individually assessed. Their care and treatment was planned and delivered in line with their individual needs.

People told us that they felt safe in the home. We found that staff had all received training in the safeguarding of vulnerable adults.

We saw how the manager monitored and managed staff training to ensure that their skills remained relevant and up to date. We also saw that staff were regularly supervised and appraised. Staff told us that they felt well supported by the management.

We saw that the home had a well publicised complaints scheme in place. We also saw that the manager had responded appropriately to complaints received.

People told us that they were happy in the home and that they felt safe. People said that the staff were, “Usually pretty good on anything” and that, “You can always get the help you need”.

We found that people had been involved in planning their own care. Care plans were person centred and designed to help people retain as much independence and control as they were able to.

People told us that staff respected their views and, “Don’t make me do things I don’t want to”. We saw staff taking time to ensure that people understood what was said to them. We saw staff treating people with respect and in ways that protected their dignity.

We found that medicines were safely stored, handled and administered. Medicine records were accurate and doctors’ instructions were properly acted upon.

We found that appropriate checks were properly carried out on staff before they were allowed to start work. We also found that there were robust internal audit systems in place to monitor and improve the quality of the service in the home.

This inspection took place on 6 and 7 May 2015 and was unannounced.

Ditton Priors Care Centre provides accommodation and personal care for older people and people living with dementia for a maximum of 23, when we carried out the inspection 20 people were living at the home.

The home had a registered manager in post who was present for our inspection. 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.

There were not enough staff on duty at all times to ensure people’s needs were met. People did not always receive their prescribed medicines as directed by the GP and some medicines were not securely stored. The home was unclean and placed people at risk of cross contamination.

People told us that they felt safe living in the home. Staff had received safeguarding training and were aware of how to protect people from harm. Staff were aware of their responsibility of sharing concerns of abuse with the manager and other agencies. Risk assessments were in place that told staff how to support people safely and we saw that accidents were recorded and action taken to reduce the risk of it happening again.

Staff were supported by the manager and had access to regular supervision. People’s consent for care and treatment was obtained. Where people lacked capacity to give consent, there was no evidence of what action the provider had taken to ensure that the care and treatment they received was in their best interest. People told us that they were happy with the meals provided and we saw that they had access to drinks at all times. We saw that people had access to other healthcare services when needed.

People told us that there were not enough social activities provided. They said they were confident to share complaints with staff or the manager and action would be taken to resolve them. We saw that past complaints had not been addressed.

The provider had identified areas in the home that placed people at risk of harm but action had not been taken to protect them. Quality monitoring audits were in place but these were not robust to ensure that people received a safe and effective service. Systems were in place to enable people to tell the provider about their experience of living in the home and to have a say in how the home was run. People and staff were aware of the management team and they felt supported.

We identified breaches of Regulations. You can see what action we have told the provider to take at the back of this report.