The inspection was unannounced and took place on 14 and 15 December 2016.

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 30 people. There were 25 people living at the home on the days of the inspection.

Since the last inspection the registered manager left the service and a new manager had been appointed five weeks prior to our inspection but had not yet registered with CQC. 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 the last inspection on 10 and 12 May 2016 we asked the provider to take action to make improvements as care was not provided in a person centred way as people were not given adequate support to maintain their appearance. Improvements were also required to in checks and audits to ensure they were robust enough to take action to improve standards. The provider submitted an action plan to us telling us how they were going to put things right to improve people’s experience of living at the home.

This inspection found some improvements had been made, the provider had followed their plan and legal requirements had been met. Relatives and staff told us the cleanliness of the home had improved and our observation supported this. Care was provided in a person centred way and people were supported to maintain their appearance and checks were now made on the experiences of people living at the home.

However, we did find that some areas still required improvement. For example, although group activities were in place that people enjoyed, people did not always receive support to engage in individual activities that meet their personal needs. Processes to record complaints and safeguardings also need improve to ensure that learning was taken to improve future outcomes for people.

People were safe and well cared for and staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were safely supported.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm and who understood how to meet their individual care needs safely. Staff knew their responsibility to report any concerns and were confident that action would be taken.

People needs were met promptly. Both relatives and staff said that there were sufficient staff numbers to meet people’s needs and we saw staff responding to people in a timely way.

The assessment of people’s capacity to consent had been completed. People’s rights and freedoms were respected by staff. Staff understood people’s individual care needs and had received training so they would be able to care for people in the best way for them.

People told us they enjoyed meals times and were positive about the choice of food they received. There were good links with health and social care professionals and staff sought and acted upon advice received, so people’s health needs were supported.

People using the service were positive in their feedback about the service. They told us they felt staff were caring and that they knew how to look after the people who lived at the home. Relatives said people’s privacy and dignity was maintained and our observations supported this.

People were encouraged to express their views and give feedback about the service. Relative’s said staff listened to them and they felt confident they could raise any issues should the need arise.

A new manager had been appointed and both relatives and staff told us improvements in the management of the home had been made. Staff spoke highly of the new management team and of the teamwork within the ser

The inspection was unannounced and took place on 10 and 12 May 2016.

The home is registered to provide accommodation and personal care, and the treatment of disease, disorder or injury for a maximum of 30 people. There were 26 people living at the home on the days of the inspection. There was 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.

People were cared for by staff who had a good understanding of protecting people from the risk of abuse and harm. Staff knew their responsibility to report any concerns and were confident that action would be taken.

Relatives told us the cleanliness of the home could be improved and we made observations that supported this. We found some equipment, for example tray tables and walking frames, were dirty.

Staffing arrangements did not provide a person centred approach to meeting people’s needs at all times. People and staff told us people sometimes had to wait for support. The registered manager told us that staffing levels were based on the dependency of people and occupancy levels and a new member of staff had been appointed to increase staff numbers.

Staff were able to demonstrate they had sufficient knowledge and skills to carry out their roles effectively and to ensure people who used the service were supported and they told us they were supported by the management through supervisions and team meetings.

The assessments of people’s capacity to consent had been completed. People’s rights and freedoms were respected by staff. Staff had received training so they would be able to care for people.

People’s nutritional needs were met. People told us they enjoyed their food and were given a choice of meals and were supported with drinks throughout the day.

People liked the staff who cared for them, however their dignity was not respected. People wore marked and creased clothes and they had not been provided with person centred support to maintain their appearance.

People told us they staff respected their choices however care records we viewed did not show when people were involved in reviewing their care and relatives said communication could be improved.

People were supported to access health care professionals and staff were responsive to the advice received in providing care.

People told us activities had improved, however we found people did not always receive support to engage in meaningful activities to meet their personal needs.

The management team had systems in place to check and improve the quality of the service but checks and audits were not robust enough to ensure that actions had been applied in practice to improve standards.

Feedback from people and their relatives has been sought to help develop and improve the service provided to people.

You can see what actions we told the provider to take at the back of the full version of this report.

We carried out an inspection to help us answer five questions;

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with eight of the people using the service and one of their relatives, three care staff supporting them and looking at three people's care records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who used the service told us that they felt safe. One person told us, "I feel safe here". Safeguarding procedures were in place and staff understood their role in safeguarding the people they supported. Staff were aware of the provider's whistleblowing policy.

People's independence, rights and choices were protected because the provider had procedures in place to gain people's consent to the care and support they received. Where people were not able to give consent the provider had acted in people's best interests and met legal requirements.

Staff knew about risk management plans and we saw that they supported people in line with those plans. This meant people were cared for in a way that protected them from harm.

The manager ensured that staff rotas were planned in advance to maintain the staffing numbers required to provide care in a safe way.

Systems were in place to make sure that the manager and staff learned from events such as accidents and incidents, complaints and checks made on the service. This reduced the risk to people and helped the service to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We saw that an application had needed to be submitted for one person and that this had been completed in line with legal requirements.

Is the service effective?

People’s care needs were assessed with them. All of the people we spoke with told us they were involved in their care planning and reviews of care. We saw that care plans were regularly updated.

Where people had complex needs that required the input of specialist health care services, assessments had been made by the appropriate professionals. Their recommendations were carried out by the staff. This meant the provider worked well with other services to ensure people's health care needs were met.

Staff were well supported and trained to ensure they effectively met people's needs.

Is the service caring?

People were supported by care staff that were kind and caring. We saw that care staff gave people encouragement and respected their privacy and dignity. One person told us, "The manager and the staff are very kind to us".

People’s preferences, interests and diverse needs had been recorded and care and support was provided in accordance with people’s wishes.

Is the service responsive?

People had the opportunity to plan and engage in a range of different activities each day.

People were asked their views about the service and the provider acted on comments and suggestions that people made.

Where care staff had noticed people's changing needs, their care plans were updated to reflect this. This was because staff discussed people's care needs with them on a regular basis. People told us staff would always do their best to make sure they were happy.

Is the service well led?

The provider had quality assurance and risk management systems in place. We found the registered manager checked that risks were managed effectively.

The provider sought the views of people who used the service. Records seen by us indicated that shortfalls in the service were addressed

Staff told us they were clear about their roles and responsibilities and understood the quality assurance and risk management systems. This helped to ensure that people received a good quality of care. Staff told us the home was well organised and they felt supported by their manager.

25 people were living in the home when we visited. We spoke with three of them as well as with one of the provider’s senior managers, the deputy manager and three members of staff. The staff we spoke with included including care, catering and domestic staff.

The people we spoke with told us they were happy with the home and the staff. One person told us: “The staff are lovely to me. I have a joke with them.” Another person said: “The atmosphere here is good. I feel very fortunate to be here.”

We watched staff as they cared for people. They provided care and support that met people’s needs.

We found that staff knew about the needs of the people they were caring for. We looked at care records for three people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found that people were able to have a choice of suitable and nutritious food and drink in sufficient quantities to meet their needs.

We found that people’s medicines were managed appropriately. This ensured people received their medicines as prescribed.

We saw that there were enough staff available to support people to meet their needs in a way that they wanted.

There was a system in place for people to make complaints if they were not happy with any aspect of the service.

18 people were living at the home when we visited. We talked with two of them as well as two visitors. We also spoke with the manager and two staff.

The people we spoke with told us that they were happy with the home and the staff. One person told us, “The staff are good as gold,” and another said, “The staff are always very pleasant and helpful.”

One of the visitors said, “The home’s handy and it’s got a nice atmosphere. It’s got a nice feel.” They were pleased with the care their relative was receiving and told us, “He’s looked a lot better since he’s been here.”

Staff knew about the needs of the people they were caring for. We looked at care plans for two people and found that these contained guidance for staff on how to meet their needs. We saw that people’s needs were reviewed regularly.

We found the equipment that was used in the home was maintained appropriately and that staff had been trained in its use.

We saw that staff were trained to an appropriate standard and we saw records which showed that the provider was regularly monitoring the quality of its service.

In this report the name of a registered manager 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 reviewed the service’s compliance with a number of essential standards in September 2011. We found that the service was non compliant with six of the essential standards.

This review was carried out to look at all the information we have received since we told the provider where they needed to improve. We visited the service to check the improvements.

People told us that they thought the home was nice and well decorated. One person told us “I like the picture on the walls, cheerful” and that the home was “very nice, like the decorations”.

We saw one person who helped arrange some daffodils on the dining room tables and appeared to enjoy this. The person told us how they liked to arrange the flowers and would help with little jobs.

People told us that the home was cleaned every day and that their rooms were well looked after. One person told us that the “cleaners are very particular, ensure the bedding is cleaned”.

People told us how relatives would take them out for meals; however, the staff did not have the time to take them out.

People also told us about the activities within the home and that they have games evenings.

During our visit we saw people singing and swaying to music, who appeared to be happy.

People told us about an entertainer who visited fortnightly and played the piano. One person told us that “it’s enjoyable, people join in and sing a song”.

One person also told us that the home “couldn’t get any better, looked after very well and very happy here”.

We saw that people were well presented, clean and looked content at the time of our visit.

We saw overall that there was good interaction with staff and residents. We saw that staff gave residents extra support where it was needed and respected people’s decisions.

We saw that staff gave extra support during meal times and saw one instance where a resident was offered their meal later as they were not hungry.

The people living in the home and their representatives who we spoke with generally expressed satisfaction with the service offered by the home and the support people received. We could not hold conversations with a lot of the people living at the home so we observed the care being provided throughout the visit.

Relatives told us that they felt the staff would contact them if they had concerns about their relative's welfare. We observed that appropriate referrals were being made to access other health professionals when needed including GPs, district nurses, opticians and chiropodist.

We observed that people had good relationships with the staff and responded positively when they were supporting people. We were told "the staff are very kind and helpful".

Relatives and staff all commented that they felt there should be more staff on duty especially for social activities and getting people out into the community. One person told us, after having taken part in an activity "it wasn't a bad morning this morning, makes a change from sitting around all the time".