We carried out the inspection on the 25 and 26 September 2017. The inspection was unannounced. Fourfields is registered to provide accommodation and personal care for up to 52 people, some of who are living with dementia. At the time of the inspection there were 48 people using the service.

At the last inspection on 25 January 2016 we rated, the service requires improvement. At this inspection, we found the service had made the required improvements.

Fourfields is divided in to six units on one level, each unit had access to the garden and their own communal lounges and dining area.

Arrangements were in place to ensure there were sufficient numbers of suitable staff available to meet people’s individual needs. The provider monitored people’s changing needs regularly to ensure the required staffing levels and where we found an area that required improvement the registered manager acted immediately to ensure cover needs were met.

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

Safe medicine practices were in place. However, there were some areas we identified that required improvement and the registered manager told us that following the inspection they had addressed these issues and processes were implemented to improve the management of medicines.

Safe and effective recruitment practices were in place. Staff had received training in how to safeguard people from abuse and knew how to report concerns both internally and externally.

People received support to maintain good health and had access to health and social care professionals when required. Risks to people’s health and well-being were identified and regularly reviewed. People were provided with a healthy balanced diet that met their individual needs.

People were involved in planning their care and received care that met their individual needs. Care plans included clear information to guide staff and there were varied activities available and events that encouraged family involvement. Staff were kind and caring, and people’s privacy and dignity was respected.

There were systems in place to obtain people’s feedback. The registered manager and the provider completed regular audits. We noted where improvements were identified these were accompanied by action plans to drive improvement at the home.

The inspection took place on 25 January 2016 and was unannounced. When we last inspected on 28 May 2013 we found the service was meeting the required standards at that time.

Fourfields provides accommodation for up to 52 people with residential and dementia needs. It does not provide nursing care. Fourfields is separated across six separate bungalows with various communal areas spread across the home. At the time of this inspection there were 45 people living at Fourfields.

There was a manager in post who was in the process of submitting an application to register with the Care Quality Commission (CQC). A registered manager is a person who has registered with the Care Quality Commission (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.

People and their relatives told us they felt safe living at Fourfields. Staff demonstrated an awareness of matters relating to safeguarding vulnerable adults from abuse. Risks identified in relation to people’s mobility or risk of falls were identified and managed. People told us there were sufficient numbers of staff to support them; however our observations at lunchtime demonstrated staff were not effectively deployed to support people who required assistance with their meal. People were not always supported by staff who had been safely recruited. There were sufficient measures in place to ensure people received their medicines safely.

People were supported to eat a nutritious and healthy diet; however they were not always supported to eat independently in a calm and settled manner. People told us that staff knew how to support them and staff said they felt supported by the management and received adequate training and development. When making decisions about people’s health needs who lacked capacity, staff did not always follow the appropriate guidance. People were supported by a range of healthcare professionals when needed.

People told us that the staff were caring, supportive and treated them with dignity whilst respecting their privacy. Staff knew people’s individual’s needs and preferences and people were involved in the day to day decisions about their care. Throughout the inspection we saw that staff assisted people in a dignified and unhurried manner. They approached people in a friendly and amiable manner that put people at ease.

There were arrangements for people to pursue interests and activities, however due to refurbishment works these were not always provided. People were not consistently provided with an opportunity to provide feedback about the quality of the service. People were confident to raise concerns or complaints with the manager and when they did these were responded to.

People and staff found the manager to be approachable and supportive. Systems were in place to monitor the quality of service that people received, however these were not operated effectively. Audits were carried out by the provider, however auditing carried out by senior care staff did not identify gaps in people’s care records.

At out last inspection on 26 February 2013, we found a lack of evidence that demonstrated people had consented to treatment and that staff did not have the necessary awareness of mental capacity. During our inspection on 28 May 2013 we found the provider had taken steps to address this. Staff had received training and demonstrated awareness for the process of gaining consent, and what steps they would take if a person did not have capacity.

At our previous inspection on 26 February 2013 we found that staff were not aware of people’s specific needs and that food and nutrition charts had not been consistently completed. During our inspection on 28 May 2013 we found that staff demonstrated awareness of people's needs and that food and nutrition charts were completed. We also found the provider had improved the range of activities available to people.

We found that people were provided with a choice of food and drink. Staff were aware of people who were at risk of malnutrition or dehydration so they could be supported appropriately. From a lunch meal we ate we also noted that food was unappetising.

People we spoke with told us they felt safe in the home and were protected from the risk of abuse.

Staff received appropriate support and professional development, and they were able to access training relevant to their role.

People who used the service and their relatives were asked for their views about their care and treatment and these were acted on appropriately.

We spoke with seven people living at the service, five relatives and eight staff on duty during our visit on 26 February 2013. One relative that we spoke with told us they “Couldn’t fault it”. We found that people's capacity to consent was recognised where appropriate but where people lacked capacity, this was not always identified appropriately and formally recorded.

Whilst there were careplans and relevant risk assessments in place these were not always updated or reflective of care in practice. This meant that people were not consistently receiving the support that they needed.

There was a policy for the management of medication which included administration of covert medication. Staff received training before they administered medication.

We observed a complaints policy accessible within the service and found that complaints were dealt with in a timely manner and where possible, to the satisfaction of people or their relatives.

The people who use the service told us that their privacy and dignity was respected. They also said that they were being well-cared for and that they did not have any concerns or complaints. The people we spoke with felt that their views were listened to and acted upon and that they were happy with the quality of service provided for them.