We carried out an unannounced comprehensive inspection at Nova House on the 13 and 20 April 2016 and we rated the service as requires improvement. We carried out this inspection on 1 June 2017 to ensure the provider had taken appropriate action and we found that the required improvements had been made.

Nova House provides accommodation and support for up to 30 older people living with a dementia type illness. Some people are independent and need only need minimal assistance; others need support with personal care and moving around the home safely. There were 28 people living at the home during the inspection.

The home is a converted older building that has been extended and includes a bungalow to the rear. The bedrooms are on three floors, there is a passenger lift and a chair lift to enable people to access all parts of the home and there is a secure garden to the side and rear of the building.

The registered manager was present during the inspection. 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.

This inspection took place on the 1 June 2017 and was unannounced.

The provider had effective systems in place to assess and monitor the services provided. The registered manager said they audited all aspects of the care provided and the facilities to identify if any improvements were needed. People, relatives and staff were encouraged to be involved in developing the service and they said the registered manager was always available to talk to.

People and relatives said the staff were very good and they provided the care people wanted, whilst supporting them to be independent and make choices. Staff had a good understanding of people’s needs and they followed the guidance in the individualised risk assessments so that people were safe.

There were enough staff working in the home to support people. Effective recruitment procedures ensured only suitable staff worked at Nova House and relevant training was provided to ensure that staff were aware of their roles and responsibilities. Staff had attended safeguarding training and demonstrated a good understanding of how to protect people from abuse and what action they would take if they had any concerns.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and DoLS and were aware of current guidance to ensure people were protected. People had been supported through best interests meetings and referrals for DoLS had been made to the local authority to ensure people were safe.

A range of group and one to one activities were provided for people to participate in if they wished; these were flexible and depended on what people wanted to do each day. People said the food was good, choices were available and staff assisted people as required.

People had access to health professionals as and when needed. Visits and appointments were recorded in the care plans with details of any changes and relevant guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed near the entrance to the building, and given to people and relatives, when they moved into the home. People and relatives said they knew how to complain and had no concerns.

Nova House provides accommodation and support for up to 25 older people living with a dementia type illness. Some people are independent and require little assistance, while others require assistance with personal care, daily living and moving around the home. There were people living at the home during the inspection.

The home is a converted older building that has been extended in the past to include a bungalow to the rear. Bedrooms are on three floors, there was a passenger lift and a chair lift to enable people to access all parts of the home and a secure garden to the side and rear of the building.

The registered manager was present during the inspection. 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.

This inspection took place on the 13 and 20 April 2016 and was unannounced.

The quality and monitoring system was not effective in all areas and had not identified some issues, such as the improvements needed in the management of medicines. The registered manager started to address these during the inspection and audits had been completed for other areas.

There were enough staff working in the home to meet people’s needs and appropriate recruitment procedures were in place to ensure only suitable people worked at the home. However, the allocation of staff did not ensure people were safe at all times.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The management and staff had attended training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards and were aware of current guidance to ensure people were protected.

People were assessed before they moved into the home to ensure staff could meet their needs, and care plans, including risk assessments to ensure their safety, were developed from this information. Care plans were reviewed and people and their relatives were involved in discussions about the care and support provided. Staff showed they understood people’s needs and provided the support and care people wanted.

People said they felt safe and relatives told us the staff ensured their family members were safe and well looked after. Staff had attended safeguarding training and demonstrated a good understanding of how to protect people from abuse and what action they would take if they had any concerns.

People told us the food was good. Choices were available and staff asked people what they wanted to eat and assisted them with their meals if required.

People had access to health professionals as and when they required it. The visits were recorded in the care plans with details of any changes to support provided as guidance for staff to follow when planning care.

A complaints procedure was in place. This was displayed on the notice board near the entrance to the building, and given to people, and relatives, when they moved into the home. People, relatives and visitors said they knew how to complain, but they did not have anything to complain about.

There were are range of activities for people to participate in if they wished, these were very flexible and depended on what people wanted to do each day. Some people had their preferences, one person liked doing jigsaws, and other people preferred not to take part in group activities and remained in their rooms.

Feedback was sought from people, their relatives and other visitors to the home through satisfaction questionnaires. People, relatives and staff said they management were very approachable and were available at any time to discuss the support and care provided.

The purpose of this inspection was to follow up areas of non-compliance which were identified during our previous inspection on 29 April 2013.

During this inspection we spoke with the registered manager and the deputy manager. We also looked and a range of documentation, including staff recruitment records, four care plans and medication administration records (MAR).

We found that improvements regarding outcome 21 had been made and identified shortfalls in the quality of record keeping had been addressed.

At the last inspection this home on 11 May 2011 shortfalls were identified and compliance actions set for the following outcome areas, safeguarding people who use services from abuse, management of medicines, supporting staff and the assessing and monitoring the quality of service provision. Improvement actions had also been set to address minor shortfalls identified in relation to consent to care and treatment and infection control. Our most recent visit found that with the exception of the outcome area relating to infection control, the provider had taken action to address the shortfalls and the home was now compliant in these areas.

We spoke with three people who lived at the home, three visitors and two people's relatives. Everyone we spoke with told us that they were happy with the delivery of care at the home and that they had no concerns.

We looked at the results from the home’s own satisfaction survey that people living at the home had completed and found that there was a high level of satisfaction with the care delivered and services provided at the home.

People told us that staff provided the supported they needed, when they needed it and that if they needed to ring a call bell, staff responded quickly. People who lived at the home and their relatives told us that staff were kind and understanding and never rushed them or raised their voices.

People who lived there and their relatives told us that people's health care needs were met. They told us that visits by doctor and other health care professionals were arranged if needed and that people received their medicines safely.

We observed that people were able to move freely around the home and that throughout the inspection staff consulted with people about how and where they would like to spend their time and their preferences in relation to food and drink.

People who use the service were able to verbalise their views and choices. Those spoken to said that they felt that their privacy and dignity was respected and that their choices were responded to. One said that ‘all you have to do is ask they will do anything for you’.

A further individual said ‘I am able to do what I want to when I want to do it’.

Two people commented on how they were involved with the care and support provided to them and that they could change this depending on how they felt.

People receiving a service from the home were very happy with the home and the care provided. Comments included ‘I am very happy with everything the level of care is good’ ’if we want any thing all we have to do is ask’ ‘nothing could be done any better’.

A group of residents spoken with confirmed that the food was of a good quality. ‘We are all well fed’ and ‘have plenty’. ‘The meal is displayed on the board so we have time to say if you do not like it and there is also a vegetable choice’.

One further resident was enjoying an aperitif before her lunch and said ‘I look forward to my lunch ’.

One resident explained how helpful staff had been in ensuring that she attends hospital appointments and in providing emotional support.

People said that they got their medicines when they should.

People spoken with were very pleased with their own accommodation two people reflected on how much they like living in one specific area of the home. A further resident said ‘the home is very good, clean, cool and comfortable.

Everyone spoken with in the home were satisfied about the care and service provided and felt that if they made a complaint it would be responded to positively.

People's needs had been assessed before they moved into the home. People told us they were happy with the care that had been delivered. It was clear from our observations and from speaking with staff that they had a good understanding of the needs of the people living in the home and that they knew them well. We noted that care workers showed patience and gave encouragement when supporting people. We observed they were attentive and that people were not rushed.

One person told us. “They give me the help I need without any query at all. They are wonderful; I cannot speak highly enough of them. I need quite a lot of help at the moment washing and dressing and they help me to do that and encourage me to do as much as I can for myself”.

A visitor told us “I have no concerns about the care here; it’s a very good home”.

People had been cared for in an environment that was clean and hygienic.

People we spoke with told us they felt there were enough staff on duty and call bells were answered without delay. A member of the management team was available on call in case of emergencies.

The home's equipment was safe and met the needs of the people living in the home.

Whilst records had been stored securely not all records seen were up to date and accurate. Staff personnel records did not contain all the required information, medication administration records were not fully complete and care plans did not always accurately reflect current care needs.