The inspection took place on 29 November 2016 and was unannounced. The inspection continued on 01 December 2016 and was announced. It was carried out by a single inspector.

Garden House Rest Home provides accommodation and personal care to up to 14 elderly people.

The care home is established in the main house with an extension to the property named Trudy's Cottage. All rooms apart from one are on the ground floor. One room is situated on a lower level of the home and can be reached by steps or a stair lift. At the time of the inspection there were 14 people living in the main house and in the adjacent building. There was a communal snug area and separate living-come-dining area which was next to the main kitchen which led into a staff area and laundry room.

When we last inspected the service in August 2015 we found that the service did not have effective recruitment and selection procedures in place. We also found that care and treatment was not provided in a safe way and that good governance was not embedded. We asked the provider to take action which they had completed and improvements had been made.

The service had a registered manager in place. 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 had a good awareness of the Mental Capacity Act (MCA) and training records showed that staff had received training in Deprivation of Liberty Safeguards (DOLS). The service completed capacity assessments and recorded best interest decisions. This ensured that people were not at risk of decisions being made which may not be in their best interest. Staff had some understanding of the principles linked to MCA however specific training had not been delivered and there was no local policy in place.

People and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and told us they had received safeguarding training. We reviewed the training records which confirmed this.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about how they lived their lives. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained to give medicines. Medicine Administration Records reviewed showed no gaps. This told us that people were receiving their medicines as prescribed.

Staff had a good knowledge of people’s support needs and received regular mandatory training as well as training specific to their roles for example, end of life and dementia.

Staff told us they received regular supervisions which were carried out by management. We reviewed records which confirmed this. Competency assessments on staff were also carried out to ensure safe practice and reflective learning took place.

People were supported to maintain healthy balanced diets. Food was home cooked using fresh ingredients and people said that they enjoyed it. Food options reflected people’s likes, dislikes and dietary requirements.

People were supported to access healthcare appointments as and when required and staff followed GP and District Nurses advice when supporting people with ongoing care needs.

People told us that staff were caring. We observed positive interactions between staff and people throughout the inspection. This showed us that people felt comfortable with staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes

People told us that there were sufficient numbers of staff on duty. One person told us “There are enough staff here, and they are all good and dedicated carers.” Another person said, “I know a couple (of staff) have left, but the standard of care hasn’t dropped.”

We found that although the home was currently understaffed, a recruitment process had been undertaken. The provider had made suitable arrangements that ensured there was always a sufficient number of staff on duty.

On the day of our inspection, 13 older people were living in Garden House Rest Home; 11 people in the main house and two people in the extension. We spoke with five people who live in the home, one relative and four staff. Everyone spoke very highly of the home.

People chose how they spent their time, however, they were not always involved in making decisions about their care. One person told us that they felt their bath time was ‘set in stone’. People’s needs were assessed but assessments were not always up to date. As a result, care was not always planned and delivered in line with individual care plans.

People were cared for by a small staff team who knew them well. People told us that there were enough staff to meet their needs. One person told us that: “Staff always come if I ring my bell, if they are busy they come and tell me so”. One person said, "I'm happy enough here. They look after me very well". The staff team had got smaller over the last year and this meant the managers were working on shift.

The home did not have effective systems in place to monitor the quality of the service or to assess and manage risks to people living in the home. People’s care records were not consistently completed and did not include an accurate record of the care that they should receive. Most of the records of people's care plans we saw had been completed, however, there were significant gaps and omissions regarding daily recording and a fall had not been recorded.

We spoke with nine people who lived in the home who told us that staff provided the care and support they needed. Everyone we spoke with spoke very highly of the home. People said staff were very patient and kind and they listened to them.

People spent their time as they wished. Some people chose to watch TV, listened to music or joined in with activities. Others chose to read books or newspapers. Regular activities were arranged, as were trips out of the home. One person said “there is a lot going on here. You choose what you want to do. We have activities most days, coffee mornings, an annual garden party and trips out of the home. We have one this week to Lyme Regis. We held a jubilee fete last weekend and we all joined in to help and run stalls. We donate the money to charity”.

People who lived in the home told us they felt very well cared for and that staff were available when they needed them. People said staff helped them to do the things they needed help with. Comments from people included “it’s very good here. All of the staff are very nice and they all know what care I need”, “they understand what help I need and they are all very caring”, and “I’m perfectly happy. They look after me very well”.

People told us they liked the food served in the home. They chose where they wished to eat their meals; most people preferred to eat in the dining areas. We saw that lunchtime was a very relaxed and sociable event. One person said “the food is very good. If you don’t like a particular meal they will always make you something else. You always have a choice and they like feedback on the food as well”.

People we spoke with said they thought the home was a safe place for them to live. Comments included: “yes, it does feel like a safe place to live”, “oh yes, I do feel very safe living here” and “this is a safe place to live. It feels just like your own home”.

People said they would raise any concerns if they had any and would be happy to share these with staff. Every person we spoke with said they were very happy with the home and had never had cause to complain. Comments from people included: “I have never been unhappy here and have never had a problem”, “I’ve never been unhappy about anything since I have lived here. It’s a lovely place to live” and “I’m perfectly happy here”.

People who lived in the home said staff were available when they needed them and they understood the care and support they needed. One person said “There are always staff around and they check on me to see if I’m all right. They check on me during the night as well”. Another person said “they look after me very well. All of the staff are very good”.

People told us they were asked to give their views on the home and that they were listened to. They said they felt able to raise any issues with any of the staff. One person told us “staff and the owner always ask for your opinion. They like feedback on things. They always listen to you. They want to make sure people are happy living here. I’m glad I chose to live here. It’s one of the wisest decisions I’ve ever made”.

The inspection took place from 5 August 2015 to 11 August and was unannounced. The home is a residential care home and provides support, assistance and personal care for up to 14 older people. The care home is established in the main house with an extension to the property named Trudy's Cottage. All rooms apart from one are on the ground floor. One room, situated on a lower level of the home has steps and a stair lift fitted. At the time of the inspection there were 12 people living at the home and in an adjacent building.

Garden House was last inspected on 30 September 2014. The home was found to be not meeting the required standards in care and welfare, management of medicines, assessing the quality of the service and not always notifying us of incidents. Improvements had been made to the care of people and managing medicines. However, further improvements were needed in the governance and sustainability of assessing the quality and monitoring of the service.

People were not being protected because the recruitment of new staff was inconsistent. The manager was unaware of the importance of procedures like checking staff references before they were employed.

While risks to most people were identified, some people were not kept safe because risks had not been fully assessed. Oxygen was in use but the risk assessment did not include the risk of fire or how to store the cylinders correctly. The assessment did not include the risk posed to other people using the service.

Staff understood how to protect people from abuse and bullying. They explained the circumstances which could lead to people being abused or neglected and the actions they would take. There was sufficient staff to support people and meet their individual needs. One relative said, “There is plenty of staff about and they are always willing to help”.

People received the medicines they needed on time. Medicine charts were checked before medicines were administered to each person and the record was signed as given.

The service was not effective. Staff were not fully aware of the relevant requirements of the Mental Capacity Act 2005 (MCA) and how this could impact on care. Most people living at the service had capacity to make day to day decisions, although it was unclear how staff were assessing people’s mental capacity as their mental health and medical conditions changed.

People received health support through referrals to healthcare professionals including audiologist (hearing specialists) community nurses and from regular contact with their GP. People received sufficient food and drink to meet their individual needs. People told us they had enough to eat and drink and that food was hot.

Staff were trained to provide care and support to people living at Garden House. They attended a variety of training including medicine management, food hygiene and safeguarding adults.

People were cared for by staff who demonstrated understanding and consideration for people’s needs and their circumstances. Staff made time to attend to important aspects of people’s care like cleaning their glasses and checking they had enough toiletries and other resources. One person said, “Staff are caring, they look after me very well, the same ones, and the same staff.”

Several people wished to remain as independent as possible and staff provided examples of how they understood what this meant to people.

The service was responsive to people’s needs. People told us they felt they could talk to staff and the manager if they had concerns or wanted to discuss anything. People and their families were involved in regular opportunities to provide feedback and the results were used to make changes to the service that people received.

Adjustments were made where people’s needs changed following discussion with them and their families. Staff were aware of the individual and varying abilities of people and provided examples. These included where people used walking frames to assist their movement around the home and became tired, then wheelchairs were made available.

The service did not have a registered manager. When we visited there had not been a registered manager in post for the last 22 months. 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 lack of a registered manager impacted on the support, leadership and guidance to staff. Improvements made since the previous inspection were unlikely to be sustained. Staff felt there was a lack of leadership from the manager and they were unsure on how management decisions at a senior level were made. Responsibility for the leadership of the home was unclear as management support was being provided by a relative of the provider.

The provider had not submitted a Statement of Purpose to the Commission. Services registered with the Commission are expected to supply an up to date Statement of Purpose for our records.

We found a number of Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the end of the full version of the report.