The inspection took place on 19 May 2016 and was unannounced. The location had last been inspected on 29 May 2015 and was in breach of the Health and Social Care Act regulations at that time in respect of contemporaneous record keeping, the management of medicines, meeting nutritional and hydration needs, and around privacy and dignity issues. We received an action plan from the registered provider, who told us all actions would be completed by 19 August 2015 and we confirmed at this inspection that all actions had been completed.

Inwood House provides accommodation and personal care for up to 55 older people and people living with dementia. There were 54 people living there at the time of our inspection, 30 of whom were living with dementia.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We saw evidence that the people who lived there were supported to maintain their health and social care needs and referrals had been made appropriately to services such as chiropody, dietician, speech and language therapy services, GP, district nurses, and dental services. The home also had a good range of preventative equipment such as pressure mattresses, pressure cushions on loan from the local community equipment service plus profiling beds and moving and handling equipment which were well maintained and serviced regularly.

People who lived there and their relatives told us they felt safe at Inwood House. Staff we spoke with demonstrated a good understanding of how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents

Staff were able to identify risks specific to the people who lived there and could tell us how they minimised risks to keep people safe. Risk assessments were in place and risks had been identified with plans to reduce risk and systems and processes ensured risks to people living there were minimised.

The service practised safe recruitment to ensure staff were recruited with the right experience and behaviours for their role. Staff received regular training to ensure they developed skills and knowledge to perform in their role. Staff had regular supervision and appraisals to support their development and were encouraged to obtain qualifications in care.

The registered manager had complied with their responsibilities under the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). They had a good understanding of when a person might be deprived of their liberty.

The property had been extended and the new facilities were of a high standard to meet the needs of people living there. Signage and facilities for people living with dementia had been improved and there were activities for people to do along the corridors and reminiscence areas including a café area for people and their relatives to use.

We found all the staff to be caring in their approach to the people who lived there and treated people with dignity and respect. Staff knew the people they supported very well and were keen for people to feel they were at home at Inwood House.

Care files were person centred and evidenced people were involved in their care planning when appropriate. Families had also been consulted with to ensure preferences and views were considered when devising support plans.

The management team provided strong leadership and aimed to provide a high quality service.

The registered manager and registered provider were on site and proactive in the running of the home. Staff told us how supportive management were and told us they enjoyed their roles as carers.

The inspection took place on 28 May 2015 and was unannounced. We also visited the home on 3 June 2015 and this inspection was announced. We had undertaken a late evening visit to the provider on 5 May 2015 following information we had received about the service. The location had last been inspected on 02 August 2013 and was not in breach of the Health and Social Care Act regulations at that time.

Inwood House provides accommodation and personal care for up to 55 older people and people living with dementia. There were 54 people living there at the time of our inspection, 22 of whom were living with dementia.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Extensive work had been undertaken to the environment of the home increasing the occupancy from 35 to 55 . The building had been altered to meet all current building standard for accessibility to suit people with a range of physical disabilities. The new facilities were of a high standard, with a modern laundry and kitchen area.

People who lived at the home and their relatives told us they felt safe at Inwood House.

Staff were able to identify risks specific to the people who lived there.

Although medicines were administered safely, we found staff were out of date with training on the management of medicines and there was no system in place to check ongoing competencies. This breached Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, the proper and safe management of medicines.

We observed moving and handling practices that were not in accordance with good practice.

Although there were enough staff, they were not deployed efficiently to ensure that people’s needs were responded to in a timely manner, particularly around mealtimes.

Systems were in place to ensure staff were recruited appropriately and had the right skills and behaviours for their role.

The registered provider invested in training to ensure staff had the right skills and knowledge to perform in their role. Staff had regular supervision and appraisals.

The registered manager had complied with their responsibilities under the MCA 2005 and DoLS. They had a good understanding of when a person might be deprived of their liberty.

People had not been adequately supported at meal time during our inspection and a drink was not offered to all the people who used the service until after the main course. This was a breach of Regulation 14 (1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Meeting nutritional and hydration needs.

The property had been extended and the new facilities were of a high standard to meet the needs of people with a physical disability. Signage and facilities for people living with dementia were more limited.

People and their relatives told us staff were caring and one person described the staff as “out of this world”. Another preson told us “ I am very happy here.”

We found care records were not held confidentially behind the reception desk and there was no privacy curtain in one of the double rooms which meant the person’s dignity or privacy could not always berespected. This was a breach of Regualtion 10 (2) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

Staff knew people well and their likes and preferences. Care files were person centred and people who used the service had been involved in their compilation.

Daily logs were not contemperanous. This demonstrated a breach of Regulation 17 (2) (c) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Although people enjoyed activities on offer, we found there to be limited evidence that people were supported with meaningful occupation throughout the day.

The registered manager and registered provider were on site and proactive in the running of the home. Staff told us how supportive management were and told us they enjoyed their roles as carers.

Feedback from questionnaires was positive and any negative comments were acted on to continually improve the service.

We spoke with six people living in the home, two relatives and two members of staff. These were some of the things they told us:

“The staff are very good, nothing is too much trouble.”

“The food is lovely and there is a choice.”

“Our relative is well looked after and staff know them well.”

“There is a very low turnover of staff and they work well as a team.”

We found that people were being involved in planning their care and support and giving consent for staff to deliver that care.

Medicines were being handled appropriately and people were receiving their medication safely and at the right times.

Our conversations with people and staff, together with observations on the day of our inspection evidenced that there were enough staff on duty.

People were aware of the complaints procedure and we saw that complaints that had been received had been dealt with and resolved.

During our visit we spoke with three people who lived at Inwood House and two visiting relatives to gain their views of the service.

People living in the home told us they liked living there. One person commented “I’m very happy living here” and another said “I want for nothing.”

People spoke of being encouraged and supported to make choices and maintain their independence. One person explained “I can choose to stay in my room in my own company, or I can go to spend time with other people in the lounge or dining room when I want.” Another person told us “Staff help me to bed when I’m ready and leave the TV on for me so I can turn it off myself when I’m tired.”

Relatives also spoke positively about the home. One relative said “I looked round lots of homes before choosing this one due to the way it looks and the positive attitude of the staff.”

People told us they received good care from the staff team. One person said “Staff call in to check on me through the night when I’m in bed to see if I need anything.” Another person told us “I always have my call buzzer handy and the staff always come quickly when I press it.”

Both of the relatives spoken with told us the home communicated well with families and kept them informed. They both confirmed they were involved in the review of their relatives’ care planning documentation each year and were complimentary about the level of care provided by the staff.

People spoken with said they felt safe living at the home. One person said “All the staff have been so kind and considerate and can’t do enough to help.” Another person commented “I feel comfortable and safe living in this home.”

All people spoken with were complimentary about the staff working in the home and felt there were sufficient numbers to meet peoples’ needs. A relative told us “The staff here look after my mum much better than we could have done ourselves at home as they have enough good staff to do it around the clock.”

All people spoken with said they did not have any complaints about the service, but all said they would feel comfortable discussing any issues with the staff or managers and believed their concerns would be resolved.