This inspection took place on 8 and 9 May 2018 and was unannounced.

Faithfull House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. Faithfull House does not provide nursing care. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

The care home can accommodate 72 people in one adapted building. At the time of this inspection 68 people lived there. Eleven of these people lived in a separate dementia care unit called Bluebell.

People’s private accommodation varied. People had varying size bedrooms of which some had a sitting room area. All had private washing facilities. People had access to additional communal lounges, dining areas, adapted toilets and bathrooms. Bluebell unit had its own lounge and dining space. At the time of the inspection the communal space for people on Bluebell unit was being increased to better accommodate people’s needs. People had access to a large conservatory and well-tended garden with summer house. People who lived on Bluebell unit were supported to use other areas of the home, if doing so, supported their wellbeing.

The service was rated ‘Good’ overall following our first comprehensive inspection on 5 and 6 January 2017. We then carried out a focused inspection on 20 and 21 July 2017 in response to concerns shared with us about people’s care. This focussed inspection looked at the key questions Is the service safe and Is the service well-led? We identified three breaches of regulation and the rating for the service was changed from ‘Good’ to ‘Requires Improvement’ following this inspection. This was the first time that the service had been rated ‘Requires Improvement’.

At the July 2017 focused inspection we found risks to people had not been sufficiently identified and action had not always been taken to reduce or mitigate risk in order to keep people safe from harm. Incidents which had an impact on people’s safety had not always been appropriately reported to the CQC or to other agencies as is required. Systems and processes used to monitor the service had not identified these shortfalls and had not led to improved outcomes for people

We asked the provider to complete an action plan to show what they would do and by when, to meet the necessary regulations and to keep people safe from potential harm. Also, how they were going to improve the key questions Is the service safe and Is the service well-led? to Good. The provider informed us on 22 September 2017 that they had completed their action plan.

During this full comprehensive inspection on 8 and 9 May 2018 we found all necessary regulations had been met. We also found all key questions Is the service safe, effective, caring, responsive and well-led? could be rated as Good. Following this inspection the overall rating for the service was ‘Good’.

Faithfull House is required to have a registered manager of which one was in post. A registered manager is a person who has registered with the CQC 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.

During this inspection we found the home to be operating in a safe way. Risks to people’s health were identified and managed and either reduced or mitigated. The same had been done with environmental risks. The safety and care of people who lived with dementia had improved through the formation of a separate dementia care unit called Bluebell. People who were at particular risk of harm, due to behaviours sometimes associated with living with dementia, were protected from harm and distress. Staff who supported people on Bluebell unit were skilled and knowledgeable in identifying situations and behaviours which could lead to upse

We carried out this unannounced focussed inspection on 20 and 21 July 2017.

This inspection was prompted in part by concerns we received in relation to the care of people who lived with dementia. These included the lack of availability of appropriately and suitably trained staff and inappropriate and unsafe delivery of care. As a result we undertook a focused inspection to look at these concerns.

This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Faithfull House’ on our website at ‘www.cqc.org.uk’. The previous inspection was carried out 5 and 6 January 2017. At that inspection the service was rated as “good” and was meeting all of the relevant regulations. There was some area for improvement identified regarding the personalisation of people’s care plans. As a result of this inspection we found three breaches of regulations. These relate to the assessment, planning and delivery of safe care and treatment, the reporting of incidents and the governance and monitoring of the service. Our findings at this inspection have changed the current rating of ‘Good’ for the key questions Safe and Well-led to ‘Requires Improvement’ and the overall rating of this service has changed from ‘Good’ to ‘Requires Improvement’. The provider has subsequently given us an update on the actions taken to improve the practices and processes involved in keeping people safe and in ensuring that improvements to these are sustained. We will inspect these actions at the next inspection of the service.

Faithfull House is registered to care for a maximum of 72 people. The service provides care for older adults, some of whom also live with dementia. At the time of the inspection there were 65 people living there. Accommodation is provided across three floors and on different levels. These can be accessed by stairs and passenger lifts. Outside there is parking to the front of the building and at the rear a large, adapted garden with summerhouse. There is a ramp at the front and rear of the building for easy access by wheelchair.

The service is required to have a registered manager. At the time of the inspection there was not a registered manager in position. 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. A new manager had been appointed in November 2016. They had submitted their application to become the registered manager for the service to CQC to ensure the provider would meet their registration requirements.

During the inspection we observed people receiving support from staff in a caring way, but at other times, people who lived with dementia, did not receive the support they needed to stay safe. We observed delays in people receiving support when they became anxious and agitated placing them at risk of their behaviour escalating which could harm them or others. For those people who required support with their behaviour, detailed positive behaviour plans were not in place that addressed all the risks associated with their behaviour. For example although their care plans informed staff that they needed to monitor or assure people; their care plans did not inform staff of what might trigger their behaviour, strategies to prevent their behaviour from escalating and how to keep them and other’s safe if their behaviour was to escalate. Without clear risk management strategies in place new staff who did not know people well and people newly admitted to the service, whose needs might not be known to all staff, might therefore not always receive consistent and appropriate support from all staff to ensure they were always supported to manage their behav

This inspection took place on 5 and 6 January 2017 and was unannounced. Faithfull House provides accommodation for 72 people who require personal care. 62 people were living in the home at the time of our inspection.

Faithfull House is a large Grade II Listed building. People’s bedrooms are set over several floors, most of which are accessible by stairs, lifts or stair lifts. The home has two large lounges and a dining area on the ground floor plus two other smaller lounges, a conservatory, library and a secure garden.

The director of care held the shared position as 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.

People told us they enjoyed living at the home and they felt safe. We observed that staff were courteous and polite towards people. Staff understood the importance of respecting people’s dignity and privacy. Staff supported and encouraged people to make their own decisions and choices. They understood the importance of acting in people’s best interests however there was limited records that people’s mental capacity had been assessed prior to significant others making decisions on their behalf.

People’s support needs and risks had been assessed and were mainly managed well. Their care records were being reviewed nod updated to ensure they reflected people’s needs and provided staff with adequate guidance. People received their medicines in a safe and timely manner and were referred to health care services when their needs had changed.

Staff had been trained to carry out their role and were knowledgeable about good care practices and their responsibilities to protect people from harm and abuse. Staff felt supported by their seniors and manager. Plans were in place to ensure staff received one to one support meetings to discuss their role and self-development. Systems were in place to ensure people were regularly checked and monitored. Adequate recruitment processes were in place to ensure people were cared for by suitable staff.

People enjoyed a variety of activities in the home and community. Concerns from people and their relatives were addressed immediately. People told us they enjoyed the meals and snacks provided. People with special diets or preferences were catered for. A chef who had recently been appointed planned to consult with people about the food being provided.

A temporary management structure was in place to ensure the home ran smoothly. Some governance and quality issues had been highlighted by the new management structure although actions were being taken to address the shortfalls. Staff felt supported by the management and were confident in the provider.

During the inspection we gathered information about how the service involved people in decision making and social activities. Arrangements were in place to enable people to partake in social activities and to be involved in the local community, if this is what the person wanted. Care was delivered in a very personalised way, with people being treated as individuals and their privacy and dignity maintained. Staff in the home co-operated with and worked alongside other providers and professionals to ensure people's needs were met. One visiting professional said "they are brilliant here" and one person using the service said "they are very patient with me". A visitor said when talking about their relative's care "it is all done with respect".

The provider had robust arrangements in place to make sure people were protected from abuse and the home adhered to these. The home was staffed in a way that allowed for individual people's needs to be met.

There were systems in place, both at provider level and home level, to monitor service provision and safety and to make improvements where needed. The views of people who used the service and those of visiting professionals had been gathered to help with this.

Records relating to care and care planning were not always accurate and did not always sufficiently reflect the care and care planning that had taken place. Records were kept secure and other records inspected, in relation to the management of the home, were fit for purpose.

Faithfull House is a care home for up to 72 older people, some of whom may be living with dementia. At the time of our visit there were 65 people living at the home.

The service had a registered manager who was responsible for the day to day operation of the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and has the legal responsibility for meeting the requirements of the law like the provider.

People told us they were happy living at the home and care workers knew their individual needs and how to meet them. We saw there were good relationships between people living at the home and staff.

People were involved in developing their care plans, how they wanted to spend their day and people said they made decisions about their care and support. They told us that staff encouraged and promoted their independence.

People told us they felt respected by staff and their dignity was maintained. We saw that people were supported to go out into the community and some people were involved in co-ordinating and participating in activities.

Staffing levels were regularly monitored by the registered manager to ensure there were sufficient staff to meet the assessed needs of people. Staff received an induction, core training and some specialist training so they had the skills and knowledge to meet people’s needs.

There was a clear management structure in the home and staff, representatives and people felt comfortable talking to the registered manager about their concerns. There were systems in place to monitor the safety and quality of the service provided.

We found the service was meeting the requirements of the Deprivation of Liberty Safeguards.