This comprehensive inspection visit took place on the 23 October 2018 and was unannounced.

Dresden House is a care home. People in care homes receive accommodation and 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. Dresden House is registered to accommodate 25 people in one adapted building. At the time of our inspection 22 people were living in the home. The home accommodates people in one building and support is provided on two floors. There are three communal lounges, a dining area and a garden that people can access. Some of the people living at Dresden House are living with dementia.

There is a registered manager in post. The registered manager was not in post at our last inspection and has been at the home since February 2018. 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.

Improvements were needed as not all capacity assessments were in place or evidence of decisions being made in people's best interests. When people were being restricted applications had been made for these to be considered.

People were safe living at the home and staff knew how to recognise and report potential abuse. We found that risks to people were managed in a safe way and when people needed specialist equipment this was provided and maintained for them. When incidents occurred within the home risks assessments were reviewed and updated to reflect changes. There were safe systems in place to manage medicines.

People enjoyed the food and were offered a choice. People and relatives said they were involved with reviewing their care and when needed people had access to health professionals. The home was clean and designed for people in their preferred way. There were infection control procedures within the home that were implemented.

Staff knew people well them well and they were provided with an induction and training that helped them to support people. We found there were enough staff available to meet people's needs and the provider ensured staffs suitability to work within the home.

People's privacy and dignity was promoted and they were treated in a caring way. People were encouraged to make choices about their day. They told us they were offered the opportunity to participate in activities and pastimes they enjoyed.

Staff felt listened to and were able to raise concerns. The provider used feedback from people and relatives to bring about changes. Quality monitoring checks were completed to make improvements to the service. When things had gone wrong in the home the provider used this information so that lessons could be learnt and improvements made. We were notified of significant events that had occurred within the home and the provider was displaying their rating of the previous inspection in line with our requirements.

We inspected this service on 8 August 2017. The inspection was unannounced.

Dresden House provides accommodation and personal care for up to 25 people. People who use the service may have a physical and/or mental health need such as dementia. At the time of our visit there were 17 people using the service.

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 our previous inspection in November 2016, we found a breach in the governance of the home and the legal requirements and regulations associated with the Health and Social Care Act 2008 were not being met. We found breaches of the regulations related to managing risks to people's safe care and treatment, safe staffing levels, need for consent, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, ensuring only fit and proper persons were employed, requirement to display performance ratings and notification of incidents. We gave the home an overall rating of inadequate. We added a condition to the provider's registration, to restrict admissions and re-admissions to the home. The service was placed in 'Special Measures'. The special measures framework is designed to ensure a timely and coordinated response where we judge the standard of care to be inadequate. Services in special measures are inspected again within six months following the publication of the inspection report.

At this inspection we looked to see if the provider and registered manager had responded to make the required improvements in the standard of care to meet the regulations. Whilst we found that sufficient improvements had been made to remove the service from 'special measures,' we found further improvements were required to meet the regulations relating to consent and notification of incidents. We also found improvements were required in how senior managers assured themselves they were providing a safe service, that ensured people's health and welfare needs were fully met.

Since our last inspection visit the provider had recognised the registered manager needed more support to improve the quality of the service. A deputy manager was in post and a new care director had been appointed to provide guidance and oversight. Systems and processes had been introduced to monitor the quality of the service, but these needed to become embedded in every day practice to be consistently effective.

Following our last inspection, the provider had increased staffing levels within the home. People felt safe living at Dresden House because there were enough staff on duty to meet their care and support needs safely and effectively. Staff were recruited safely because the provider had checked they were of good character. However, improvements were needed in the application form so the provider could identify any gaps in employment history.

Improvements had been made in risk management within the home. Staff had an understanding of each person’s individual risks and ensured they used the correct equipment to keep people safe. Where people had fallen, this had triggered a review of the risks to the person’s safety. Staff had a better understanding of best practice around giving people their medicines and people received their medicines as prescribed. However, further improvements were still required to ensure all risks were managed consistently.

Staff understood their responsibility to record and report any concerns they had about people’s health or wellbeing. Safeguarding concerns had been referred to the local authority as required.

Staff had received essential training to meet people’s needs safely and effectively. However, further training

We inspected this service on 25 November 2016. This was an unannounced inspection. Our last inspection took place in August 2015. At that time we found the provider was meeting the required Regulatory requirements.

The service is registered to provide accommodation and personal care for up to 25 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 23 people were using the service.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care. Medicines were not always managed safely.

People were not always protected from the risk of abuse because suspected abuse was not always reported as required. Safe recruitment systems were not in place to ensure staff were of suitable character to work with the people who used the service.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced. There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

People told us they enjoyed the food. However, we found that some people did not always receive the support they needed to eat and drink. People’s risk of malnutrition and dehydration were not being effectively monitored.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not always followed to ensure decisions were made in people’s best interests when they were unable to do this for themselves. We identified

We inspected this service on 14 August 2015. This was an unannounced inspection. Our last inspection took place in May 2013 and at that time we found the home was meeting the regulations that we checked them against.

The service was registered to provide accommodation and personal care for up to 25 people. At the time of our inspection 24 people were using the service. People who used the service had physical health needs and/or were living with dementia.

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 and associated Regulations about how the service is run.

People’s safety was maintained because risks were assessed and planned for and the staff understood how to keep people safe. People’s medicines were also managed safely.

There were sufficient numbers of staff to meet people’s needs and keep people safe. Staff received training that provided them with the knowledge and skills to meet people’s needs effectively.

Staff sought people’s consent before they provided care and support. When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People were supported to access suitable amounts of food and drink of their choice and their health and wellbeing needs were monitored. Advice from health and social care professionals was sought and followed when required.

Staff treated people with kindness and compassion and people’s dignity and privacy was promoted. People were encouraged to make choices about their care and the staff respected the choices people made.

People and their relatives were involved in the planning of the care and care was delivered in accordance with people’s care preferences. People could also participate in leisure and social based activities that met their individual preferences.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere within the home and the manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

We carried out this inspection to check on the care and welfare of people using the service. The inspection was unannounced which meant the provider and the staff did not know we were coming. During our inspection we spoke with seven people who used the service, two people who visited the service, three members of staff and the registered manager.

At our last inspection, we found that improvements needed to be made in how medicines were stored, recorded and disposed of. We also identified that changes need to be made with how care records were stored and updated.

During this inspection, we saw that the required improvements had been made. People were protected from the risks associated with the administration of medicines, because appropriate systems were now in place. Care records were stored securely and were updated to reflect changes to people’s needs.

People told us they were happy with the care they received and we observed people getting the care that had been planned for. One person told us, “I am very comfortable here. I get whatever I need”.

People told us they were very happy with the food that was served. One person said, “All the food is nicely cooked and we are offered seconds if we want them”. We saw that choices of food and drink were made available and people’s feedback was used to make changes to the menus on offer.

People told us they felt safe and we saw that systems were in place to identify and report any concerns about people’s safety.

We carried out this inspection as part of our schedule of inspections to check on the care and welfare of people using this service. The visit was unannounced, which meant that the registered provider and the staff did not know we were coming.

We spoke with six people using this service, three relatives and six members of staff. We also spoke to a health care professional who visited the service. People using the service told us that they like living in the home. One person said, “I like it very much here, the staff are good at everything”. Relatives that we spoke with told us that they were happy with the care provided. One relative said, “I am happy with everything that they do for X”.

During our inspection we saw that people were supported to make decisions and were involved in the planning of their care. Where people could not make decisions for themselves, decisions were made in their best interests with involvement from their families.

We observed people receiving appropriate care and treatment by staff who had the required knowledge and skills to provide the care that people required.

We saw that there was a complaints system in place which people were aware of.

We saw that medications and care records were not stored securely and that systems were not in place to ensure that some medications were kept at the required temperature or disposed of appropriately.

We carried out this inspection because we had not visited the service for some time and we did not have enough information about the service to assess compliance. We wanted to see what life was like for the people who lived in the home.

We visited the service and spoke to people using the service, relatives and staff. We looked at records of care, staff rosters, minutes of meetings, medication records, quality audits of the service and observed the environment. We observed how staff and users of the service interacted and talked to people about the things they did and what they liked about the service.

There were twenty three people living at Dresden House when we visited on 02 February 2012. The visit was unannounced which meant the provider and the staff did not know we were coming. We were accompanied for part of the visit by an expert by experience. An expert by experience is some one who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. They help us improve the way we inspect and write our reports. Our expert by experience talked to people using the service individually, looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found and details are included in this report.

We arrived mid morning and found the home to be very busy. People were eating breakfast, watching television and chatting with staff.

We spoke with the majority of people living at the home. Comments included,"I've got used to it here, it's my home now." "The staff are great nothing is too much trouble and they always do as I ask," "I love being here I can't imagine living any where else and wouldn't want to."

Relatives said, "We visit at different times and always receive a warm welcome, our relative tells us they like living here."

Staff told us that, "I have regular support meetings with my manager and can discuss any concerns or ideas I may have. I made a suggestion for change last year and it was adopted," "I have been supported by all the staff and they provide advice and guidance when I need it," "I have worked here for a long time, it's a great place to work."

Our expert by experience reported, "Dresden House appeared homely and welcoming when I visited. Staff were busy but still had time for the people. People presented as comfortable and content in the main. The home is working hard to provide meaningful activities for the people who wish to be involved. One person who by their own admission did not want to move into a home and had decided that they were not going to like it told me that all they could say now was that for the first time for a long time

“I feel happy inside”".