We carried out an unannounced comprehensive inspection of this service on 8 March 2018.

The home is registered to provide accommodation and personal care for adults and who may have a dementia related illness. A maximum of 66 people can live at the home. There were 61 people living at home on the day of the inspection.

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.

At the last inspection, the service was rated Good overall with the rating of Requires Improvement for safe. This was because the provider needed to improve the medication system, which had been made and seen on this inspection.

The registered manager and staff demonstrated their commitment to care for people following best practice. They linked with care provider forums ensured people had access to the local community. The service had a good links with health and social care professionals.

The provider had a programme of audits in place to monitor the quality and safety of people’s care and support. The provider continually strived to make things work better so that people benefitted from a home that met their needs. However, further improvements are needed to demonstrate continual improvements and how these would make positive changes to how people were supported to live their lives now and in the future.

People told they felt safe living at the home and that staff supported them with maintaining their safety. Staff told us about how they minimised the risk to people’s safety and that they would report any suspected the risk of abuse to the management team. People got the help needed with staff offering guidance or support with their care that reduced their risk of harm.

There were staff available to meet people’s care needs or answer any requests for support in a timely way. People told us they received their medicines from senior care staff who managed their medicines in the right way. People also felt that if they needed extra pain relief or other medicines as needed these were provided. Staff wore protective gloves and aprons to reduce the risks of spreading infection within in the home.

People told us staff knew their care and support needs. Staff told us they understood the needs of people and their knowledge was supported by the training they were given. Staff knowledge reflected the needs of people who lived at the home. People told us staff acted on their wishes and their agreement had been sought before staff carried out a task. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the MCA. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

People told us they enjoyed their meals, had a choice of the foods they enjoyed and were supported to eat and drink enough to keep them healthy. People had access to other healthcare professionals that provided treatment, advice and guidance to support their health needs.

People told us they enjoyed spending time with staff, chatting and relaxing with them. We saw people’s privacy and dignity was maintained with staff support. People’s day to day preferences were listened to by staff and people’s choices and decisions were respected. Staff told us it was important to promote a person’s independence and ensure people had as much involvement as possible in their care and support.

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The inspection took place on 14 October 2014 and on 17 October 2014 and was unannounced. At our inspection in November 2013 we found that the home had made the improvements required from a previous inspection where warning notices had been issued about the staffing levels in the home and the care of people.

The home could provide accommodation for up to 66 older people who may be living with dementia; there were 63 people resident at the time of the inspection. Not all people could communicate with us verbally, but they were able to express their feelings through non-verbal communication. The home has two floors each with two separates units. Each of these units has communal dining and lounge areas.

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.

Care staff we spoke with did not know how the Mental Capacity Act 2005 ensured that safeguards were in place for people who lacked capacity to make particular decisions. For example the provider had not made any applications under Mental Capacity Act Deprivation of Liberty Safeguards to ensure that people who may be unsafe to leave the home were not overly restricted. Care staff did not know if any person was unsafe to leave the home unescorted or what legal safeguards were in place.

People were not always receiving all of their prescribed medicines and the arrangements for accounting for medicines and medicinal creams needed to be improved.

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

Prior to our inspection we received feedback from a local authority that was funding some people who lived at the home. They did not raise any concerns about the care people were receiving.

People and their relatives we spoke with told us that the home was safe. Staff were knowledgeable about the risks of abuse and reporting procedures. We found there were sufficient staff available to meet people’s needs and that safe recruitment practices were followed. This helped to keep people safe.

People were being cared for by suitably qualified, supported and trained staff. Staff received suitable induction and training to meet the needs of people living at the home. We saw staff showing skill in supporting people throughout the day.

People had access to appropriate health care when this was needed. Some people we spoke with told us that their health had improved and that they felt more confident since they lived in the home. People were supported and encouraged to eat sufficient to maintain their health.

Staff spent time individually with people in the home, responded when people wanted assistance or company, as well as, having scheduled entertainments planned. Staff were respectful and caring in their attitudes to people and ensured their actions did not intrude on people’s privacy.

People who lived at the home told us that they could speak to staff and management about their concerns and that they would be listened to. The provider obtained feedback from people and their relatives about the service to identify where improvements could be made.

At our inspection conducted 5 September 2013 we found the provider non-compliant with this regulation. We issued the provider with a warning notice detailing that they should become compliant by 28 October 2013.

At our previous inspection we saw that there were not enough staff to meet the needs of people. We found that people did not always receive the care they needed. Staff confirmed that they found it difficult to complete all the required care tasks to ensure that people’s needs were met. .

At this inspection the provider had increased the minimum number of staff available for each shift. There were enough qualified, skilled and experienced staff to meet people’s needs. . We saw from the staff rotas supplied that on each shift there adequate numbers of staff on duty with a range of skills and experience. We spoke to staff and they confirmed that they felt the staffing numbers had improved. We observed and noted in care plans that people had received the care they required. The provider had ensured that people received care and treatment from sufficient numbers of staff. The staff were suitably qualified and experienced for the roles and duties they carried out.

We found that staffing was actively monitored and managed by a number of systems to ensure that sufficient staffing was available on to units within the home where it was needed. This meant that deployment of staff across the whole home was managed to ensure that when staff were absent that the needs of people in all units were met. We observed this happening where one unit had lower than planned numbers of staff on duty to meet people’s needs. We noted that staff were working hard to ensure that staffing deployment did not have a detrimental effect on people’s care.

We were told that two vacancies for care staff were still outstanding, although the manager said they had people booked for interview. Previously the post of activities coordinator was vacant. During this inspection we saw that people received support from a dedicated activities coordinator. He was supported in his role by care staff. He told us: “Relatives had got involved in the activities too.”

We inspected this home on 8 and 9 December 2015. This was an unannounced Inspection. The home was registered to provide personal care and accommodation for up to 66 older people. At the time of our inspection 63 people were living at the home. The service was last inspected in October 2014 when we found the service was not compliant with two of the regulations we looked at. The issues identified that the provider did not have suitable arrangements in place to ensure people who use services were protected against the risks associated with unsafe use or management of medicines and did not have suitable arrangements in place for obtaining and acting in accordance with, the consent of people under the Mental Capacity Act 2005 and the Deprivation of Liberty safeguards. The provider took action and at this inspection we found improvements had been made.

The registered manager was present during our 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.

People using this service told us they were safe. People told us they were encouraged to raise any concerns they had and this was confirmed by relatives. We found that staff knew how to recognise when people might be at risk of harm and were aware of the registered provider’s procedures for reporting any concerns.

We received positive comments from people using the service and their relatives about the staffing arrangements in the home. We saw that staff knew people well and could describe consistently their personal preferences and preferred routines. Staff treated people with respect and the communication we observed between staff and people using the service was respectful and inclusive.

People were supported by staff who had received training and who had been supported to obtain qualifications. This ensured that the care provided was safe and followed best practice guidelines. Robust recruitment checks and induction processes were in place to ensure new staff were suitable to work with people using the service.

People received their medicines as prescribed; however, the management of medication was not always safe and improvements were needed. There were the potential for errors noted in respect of some medication administration where medicines were not needed routinely or were not in a monitored dosage system and for prescribed creams.

People told us that they were involved in the planning and reviewing of their care. People’s needs had been assessed and person-centred care plans were in place to inform staff how to support people in the way they preferred. Measures had been put into place to ensure risks were managed appropriately.

Staff we spoke with were knowledgeable of the requirements and their responsibilities in line with the Mental Capacity Act 2005. Some necessary applications to apply for Deprivation of Liberty Safeguards (DoLS) to protect the rights of people had been submitted to the local supervisory body for authorisation.

People told us they had access to a variety of food and drink. People were supported to eat and drink sufficient amounts to help them to maintain good health. People told us they were supported to have access to a wide range of health care professionals.

People told us, or indicated that they were happy living at the home. People told us that they continued to pursue individual interests and hobbies that they enjoyed and they were happy with the range of activities available to them.

People using the service and their relatives knew how to raise any complaints. The complaints procedure was displayed in different formats to support people’s preferred way of communicating.

There were systems in place to monitor and improve the quality of the service provided; these were effective in ensuring the home was consistently well led and compliant with the regulations.