This unannounced inspection took place on 21 November 2017. At our previous inspection in January 2017 we had found the service was not always safe, effective, caring, responsive or well led. We had found a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we found that improvements had been made in all the areas and the provider was no longer in breach of Regulations.

Farmhouse Residential Rest Home provides accommodation and personal care for up to 23 people, some of whom may be living with dementia. Five places at the service were for people who required a period of rehabilitation following a stay in hospital. There were 23 people using the service at the time of this inspection.

There was a registered manager in post who supported us throughout the 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.

People were safeguarded from the risk of abuse as staff followed the local safeguarding procedures when they suspected abuse.

Risks of harm to people were mitigated through the effective use of risk assessments. Lessons were learned following accidents and incidents to reduce the risk of them occurring again.

There were sufficient numbers of suitably trained staff to meet the needs of people in a safe way. New staff were employed through safe recruitment procedures to ensure they were fit and of good character to work with people.

People's medicines were stored and administered safely. There were infection control measures in place to reduce the risk of the spread of infection.

People's needs were assessed holistically to achieve effective outcomes. People were cared for by staff who were trained and supported to fulfil their roles effectively.

People's nutritional needs were met and when people became unwell or their health care needs changed the appropriate health care advice was sought in a timely manner.

People were supported with their transition into and out of the service through information sharing and partnership work with other agencies.

The principles of the Mental Capacity Act 2005 (MCA) were followed to ensure that people who lacked the mental capacity to agree to their care and support were supported to do so in their best interests.

The building and environment was being adapted to meet the needs of people who used the service.

People were treated with dignity and respect and their right to privacy was upheld.

People were involved in the planning of their care, offered choices and encouraged to be as independent as they were able to be.

People's needs were assessed and their preferences gained. We have recommended that further information is gained about people's diverse needs through the assessment process.

There were a range of hobbies and activities to support people to maintain active and promote their well being.

People were cared for with dignity at the end of their life and were comfortable and pain free.

The provider had a complaints procedure and complaints were dealt with appropriately.

There was clear vision and strategy to provide good quality of care. The governance systems the provider had in place to monitor and improve the service were effective in ensuring improvements were made.

People, their relatives, staff and other agencies were encouraged to have a say in how the service was run. The provider worked with other agencies to ensure a holistic approach to people's care.

This inspection took place on 5 January 2017 and was unannounced. This was the provider's first inspection since registering the service with us. We found that some improvements had been made since the service had been registered with this provider, however further improvements were required. We found that the service was not consistently safe, effective, caring, responsive and well led. We found one breach of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the report.

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.

Farmhouse Residential Rest Home provides accommodation and personal care for up to 23 people, some of whom may be living with dementia. There were 21 people using the service at the time of the inspection.

People's medicines were not always managed safely. Risks associated with people's mobility needs were not always managed safely and equipment had not been maintained to ensure it was safe.

People were safeguarded from harm as the staff and the registered manager knew what to do if they suspected someone had been abused. The local authority safeguarding procedures were followed when there had been an allegation of potential abuse.

People had a choice food and sufficient amounts to eat, however records relating to people's fluid intake were not always competed effectively to ensure that people had enough to drink. When people became unwell or their health needs changed they received health care support from other agencies such as GP's and district nurses.

Staff felt supported to fulfil their role and received relevant training to be effective. There were enough staff to meet people's needs, although staff we spoke with told us they needed more staff during the morning to meet people's needs in a timely manner. Not all people working at the home had been checked for their fitness of character to work with people who used the service.

The principles of the MCA 2005 were being followed as people who lacked the mental capacity to consent their care at the service were supported by their legal representatives to agree in their best interests.

Although most interactions between staff and people who used the service were respectful, there were occasions when people's emotional needs were not considered and acted upon. People had their own private room and their right to privacy was upheld.

People's preferences were not always recorded and respected, however the registered manager had a plan to gain the personal preferences of people to ensure staff were aware of people's likes and dislikes. There were a range of hobbies and activities available to people. There were trips and outings into the local community arranged. The environment was being adapted to support people living with dementia with signage and visual prompts to orientate people to time and place.

People and their relatives were encouraged to have a say in how the home was run through regular meetings. The provider had a complaints procedure and we saw informal and formal complaints had been acted upon.

There was an action plan to continue to improve the service and regular audits were completed. The registered manager and the provider had been responsive to our requirements and the local authorities concerns and had made improvements to the quality of the service being delivered.