This inspection took place on 13 and 16 October 2017 and was unannounced. The previous inspection was carried out on 18 and 19 August 2016 and there had been several breaches of legal requirements at that time. We rated the home requires improvement in all areas of the key questions which include, safe, effective, caring, responsive and well led. We found at this inspection significant improvements had been made since the last inspection. The manager had submitted monthly action plans to the Commission so that we could monitor the improvements made.

At the time of the inspection there was not a registered manager registered with the CQC. The appropriate action had been taken and manager had applied to register with the Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the home. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the home is run.

Faith House provides accommodation and personal care for up to eight people. At the time of our visit there were six people living at the home.

People were protected from abuse because staff understood how to keep them safe, including understanding the processes they should follow if an allegation of abuse was made. All staff informed us concerns would be followed up if they were raised.

There were enough suitable staff to meet people's needs. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others.

Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate staff were employed to work at the home.

People received their medicines when they required them and in a safe manner. Staff received training and guidance to make sure they remained competent to handle people's medicines.

Staff received training to ensure they had the skills and knowledge required to effectively support people. Staff felt well supported by the manager and received regular supervision sessions and appraisals.

The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 (MCA) and the DoLS. Staff had the right skills and training to support people appropriately.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People were supported to eat and drink according to their likes and dislikes. Staff were caring, kind and treated people with respect. People's right to privacy was maintained by the actions and care given by staff members.

People's personal and health care needs were met and care records guided staff in how to do this. There was a variety of activities for people to do and take part in during the day, and people had enough social stimulation.

The home supported people to maintain their health and wellbeing and people were supported to access healthcare services and any treatment required promptly.

Complaints were investigated and responded to and people knew who to speak with if they had concerns.

The manager was well thought of by staff and people and was hands-on and visible within the home. This promoted a positive culture with a strong emphasis on teamwork.

Quality assurance systems were in place to assess and monitor the quality of service that people received and identify any areas that required improvement.

This inspection took place on 18 and 19 August 2016 and was unannounced. This service was previously inspected in August 2015. At that time we found there were three breaches in regulations. Faith House provides accommodation for up to eight people. At the time of our visit there were eight people living at 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. The registered manager was also one of the two registered providers. For the purpose of the report we will refer to them as the registered manager.

People we spoke with had dementia. We kept questions simple and enjoyed general conversations with them; we also acquired evidence from observations and listening to interactions with staff. We did see smiling faces; people were conversing together and looked relaxed in each other’s company and surroundings. One person told us, “I am very relaxed and happy thank you. I like to sit here and let the world go by”.

A significant number of improvements were required across the service. The providers and registered manager had failed to monitor the service effectively to ensure people were cared for by staff who had the right skills and knowledge. Lack of specific training meant staff did not understand or have the insight in order to enhance people’s lives and to provide meaningful, person centred care. People’s dignity was not always promoted and protected.

Lack of specific risk assessments compromised safety and staff did not have clear guidance on how to manage some risks to people. Care plans did not contain enough detail to support people to receive individualised care. Plans were missing for essential diagnosis and needs; this particularly included those people with dementia.

Understanding on the principles of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards had increased, however improvements were required to extend this knowledge further.

Staff had an improved awareness of safeguarding policies and procedures and felt confident to raise any issues or concerns with the management team. People were supported by the recruitment policy and practices in the home. The registered manager and staff were able to demonstrate there were sufficient numbers of staff. Staff confirmed they were supported by the provider and the registered manager.

There was a complaints procedure in place and where complaints had been made, there was evidence these had been dealt with appropriately.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of this report.

In April 2013 we carried out a review of Faith House and we identified one area where the service needed to make improvements. Following the review the provider told us about the changes they intended to make. The area we were concerned about was in respect of supporting workers. We found that staff were not being supervised by senior staff on a regular basis.

We asked to look at supervision records for two staff. We saw evidence that staff had received regular supervision since the last inspection. One member of staff had received two supervisions since April 2013. Records were signed by the staff member and their supervisor.

We spoke with two staff members who confirmed they had received this supervision. Staff told us "I have had supervision with my manager and plan to have my appraisal soon” and “I feel supported and have had supervision and attended staff meetings”.

We spoke to three people living in the home about how staff assisted them and what the care staff were like. Comments were positive about the care and support they received. People told us “The staff offer me lots of reassurance as I am scared of falling” and “If I would like a bath I only have to ask the staff, nothing is to much trouble”.

We did not speak with all people living in the home during our visit but we looked around the whole home to ensure it was kept clean, tidy and odour free. Those people we did speak with told us they felt the home was clean and tidy and a good standard. One person did tell us "The home is always very clean and tidy”.

We asked to look at staff supervision records. We could not find any records to demonstrate that staff were being supervised on a regular basis. Staff told us that they did not receive regular formal one to one supervision or an annual appraisal with the manager to discuss their role and responsibilities. The manager and care staff told us that handovers were held on a daily basis to keep staff informed and provided staff with an update about each person's care needs.

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 CQC inspector joined by an Expert by Experience

(people who have experience of using services and who can provide that perspective). We

talked with six out of seven of the people who lived in the home and observed the care and support provided.

Some people were not able to respond to our questions in great detail but all of the people living at the home that we spoke with praised the home, the staff and the food.

One person told us that “all the staff are very good and always ask my permission before they do anything for me, or to me; they don’t take anything for granted.” They added, “I am very blessed and one of my biggest blessings is being here.”

Other people we spoke with said that they were very happy, they told us “this is a very lovely place, everybody is kind”, “it’s excellent, no complaints, everything is fine, I’m well cared for by staff and food is excellent, I’m very lucky to be here.”

One resident said, “I must say, good place, good staff everything is good, food is marvellous, before I came here I didn’t eat but now I eat everything and am putting on a bit of weight.” Another resident said “It’s very good here, plenty of food, sometimes it’s too much, but staff say just eat what you can, and leave the rest.”

A regular visitor to the home said that they thought that the home was wonderful, and were seriously considering living there when the time was right. They said they knew that the person they were visiting was very pleased with the care and would certainly say if they were unhappy about anything.

Staff had undertaken dignity and nutrition training and told us the manager planned further training.

This inspection took place on 13, 14 and 19 August 2015 and was unannounced.

The last inspection was carried out on 12 September 2013 and there were no breaches of legal requirements at that time. Prior to this inspection concerns were shared with us by health and social care professionals who had visited the service.

Faith House provides accommodation for up to eight older people. At the time of our visit there were eight people living at 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We found a number of breaches of 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 this report.

Staff knew people well enough to understand their preferences; however, they were not all familiar with the Mental Capacity Act 2005 (MCA) and their legal responsibility to support people who lacked capacity. People’s mental capacity to make day to day or significant decisions had not been assessed.

Risks had not been assessed and the appropriate assessments were not in place to reduce or eliminate the risk.

Limited activities were available and were not planned around people’s individual interests and care needs.

Effective procedures for monitoring and assessing the quality of the service were not in place.

Staff were knowledgeable about recognising the signs of abuse. All staff had received training in safeguarding adults.

Medicines were administered to people safely by staff that had been trained.

Staffing numbers on each shift were adequate to ensure that each person’s care and support needs could be met. Staff were provided with regular training.

People were satisfied with the quality of the food and drink provided. Food and fluid intake was monitored where risks of weight loss or dehydration had been identified. Arrangements were made for people to see their GP and other healthcare professionals as and when they needed to do so.

Staff were caring and compassionate. They understood people’s needs and developed caring professional relationships with people.