This inspection took place on 12 October 2016. It was carried out by one inspector.

Maiden Castle House provides nursing and residential care for up to 66 older adults. There were 61 people living in the home at the time of our visit, some of whom were living with dementia. Accommodation is based on two floors. The ground floor consists of three separate areas known as Casterbridge which has 13 rooms for people living with early stages of dementia. Duberville has 14 rooms and Hardy nine, both provide accommodation for frail older people. Upstairs is one larger space which accommodates up to 30 people who are living with dementia. There was a service improvement plan to create two smaller areas upstairs.

There was a registered manager in post; they were in their last week of employment in the home. A new manager had been appointed and they were working alongside the registered manager to ensure a smooth transition. 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.

At our last inspection of Maiden Castle in November 2014 we had concerns that the quality assurance systems were not effective and that peoples’ records were not always accurate and up to date. As well as this we had concerns that the service had not followed correct procedures as required by the Mental Capacity Act 2005 (MCA) and medicines were not always administered appropriately. We found the provider had made improvements since our last inspection in November 2014.

During this inspection there was a service improvement plan which was monitored and updated at least monthly in a quality assurance group meeting. The quality group checked that actions had been completed or were in progress. As well as this other improvements which were identified were included in the plan. For example the accommodation on the top floor was considered by the provider to be too large a space and there was an improvement plan to create two smaller units. There was an audit schedule and we saw that issues or concerns were followed up on.

The provider had introduced a new electronic system which involved a hand held device for administering medicines. Staff were alerted if an error had taken place so that they could rectify it promptly. Staff were positive about the system and told us they had received sufficient training.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so by themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff understood their responsibilities according to the MCA and the correct processes were followed when making a decision in a person’s best interests, which included consulting with a healthcare professional and the person’s relatives.

People had opportunity to participate in a range of activities which included poetry, baking, crafts and board games. There were two–three social support staff working each day and they planned activities and clubs based on people’s interests and needs. Activities were moved around the home so that people from different areas could participate if they chose to. There were resources available for care staff to utilise when social support staff were not available such as crafts and games.

There was a commitment to maintaining links with the community and this took shape in a variety of ways. For example local schools were invited into the home to be involved in activities and the home entered a float in a local carnival.

Staff we spoke with and observed were clear about how people were encouraged to maintain the skills they had. For example, one person's care plan detailed the personal care tasks they could do themselves such as washing their face.

Care was planned and delivered in a way that was intended to ensure people's safety and welfare. We found that where people had been identified as nutritionally at risk through the use of a specific assessment tool, their care plan had been updated with the changes necessary to maintain their wellbeing.

There were enough staff to assist people during lunch. We observed four people who needed support to eat their meal and there were four staff available to assist them.

There were enough staff to meet people's needs. At the time of our visit the registered manager told us there were 16 vacancies in the home. A relative told us,"Could not fault the care, the best home."

In this report the name of a registered manager (Claire Brownless) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time”.

We saw evidence in individual care plans and notes of group meetings that the provider respected and involved people. We observed people were treated with respect. People told us "I consider myself fortunate to live here" and "we have some lovely carers".

A family representative said that "the staff always try to involve people in activities". We saw that there was a variety of activities available. The provider provided personalised care, treatment and support. Peoples needs were assessed with appropriate plans drawn up and implemented.

There was guidance in the home on safeguarding people from abuse. Staff members knew how to report concerns regarding abuse. The provider had responded appropriately to allegations of abuse.

Through review of staff rotas, training records and speaking with the provider we found that there was sufficient qualified, skilled and experienced staff to provide care and support for people. We were told by one staff member that "the teamwork is good".

We saw the provider sought the views of family representatives and made changes as a result. Comments, complaints, accidents and incidents were investigated and learnt from to improve the care, treatment and support provided.

In this report the name of a registered manager (Claire Brownless) appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still our register at the time.

We visited the home unannounced on Wednesday 23 May 2012 and returned on Friday 25 May 2012. We spoke with people who used the service, staff and visitors. We reviewed care records and spoke with the interim manager.

There were two units in the home where people were not able to tell us about their experience of using the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk to us.

People's experience at meal times depended on who was supporting them. While one member of staff was assisting someone to eat they were also eating their own food. The person had to wait. During this time the member of staff also spoke with another member of staff. We saw that they hovered the spoon by the person's mouth while they finished chewing.

In another dining area we saw a member of staff talking to the person they were supporting, they explained what the food was, chatted with the person and sat beside them. While assisting the person their focus was only on them.

One person told us that staff were always polite, they felt they understood them and listened when they were upset or worried.

There were signs and pictures around the home to help orientate people to their own room as well as the lounge and bathrooms.

People we observed seemed comfortable with staff. Staff were able to respond to situations quickly. For example when someone became upset staff were able to comfort the person and reassure them.

We walked around the home. We found communal toilets and bathrooms were clean and well stocked with gloves and aprons. We found each bathroom and toilet had paper towels in a dispenser and liquid soap. There was a clinical waste bin and a separate bin for used paper towels.

We spent time in one unit on the first floor. Staff were always present in the communal lounge. In one lounge on the ground floor, there were two staff to support 14 people. There was not always a staff presence in the lounge and people were not engaged in activities.

One person we spoke with had repeatedly made comments to the manager about concerns they had about the care their relative received. They told us they did not feel listened to or taken seriously. They told us this had changed following a change of management at the home.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 18 and 21 November 2014 and was unannounced. The inspection was completed by one inspector. The home was last inspected on the 12 September 2013 and found to be compliant with the outcome areas inspected.

When we visited 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.

Maiden Castle is part of the Care South group of homes. The home provides care and support to 66 older people, at the time of the inspection there was 62 people living at Maiden Castle. Many of the staff had supported the people for a long time providing a good level of consistency.

Staff lacked the guidance and support to be able to give medicines safely and in accordance with the relevant legislation. This put people at risk of receiving medicines inappropriately.

People could be confident their care needs were being met and they were involved in the planning of their care. However some people’s care records required updating to reflect their current needs. Records relating to the care and support people required did not always give staff the information they required to keep people safe and to meet their needs in a consistent manner.

The provider, Care South, had a system in place to monitor the service offered and to make improvements where required. This system was only partially successful at bringing about change at the home as some issues identified as requiring improvement featured on many service checks carried out by the provider. This meant that whilst issues were identified plans had not been put into place to ensure improvements were made.

People told us staff support them in the way they wished. One person told us “staff never hurry me, they let me do what I can and help with what I can’t”. Another person told us “I never have to wait long for help, staff may not be able to help straight away but they do come and speak to you and make sure you’re alright, they always come back when they say they will”.

We spoke with relatives of people living at the home. They told us that the staff and management keep them informed about what is happening through group and individual meetings. Some relatives told us about a ‘community feel’ to the home and how they felt included in decisions that affected their loved ones, when appropriate.

We observed staff caring and supporting people. We noted that all interactions were kind and empathic. We observed in some areas of the home there was a lot of laughter as staff worked with the people they supported.

People were protected from the risk of abuse because there were clear procedures in place to recognise and respond to abuse and staff had been trained in how to follow the procedures.

People were supported by staff that been employed following a thorough recruitment process and had received appropriate training which was relevant to their roles. Staff told us they felt supported and valued in their roles.

The organisation’s values and philosophy were clearly explained to staff and there was a positive culture where people felt included and their views were sought.

Health care professionals told us staff provided a good level of support and care to people living there.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These breaches related to: Administration of medicines, Mental Capacity Act assessments, record keeping and quality assurance at the home. You can see what action we told the provider to take at the back of the full version of the report.