The inspection took place on 28 February 2017 and was unannounced.

Squeaks House provides personal care and accommodation for up to 29 older people, primarily those living with dementia. The service does not provide nursing care. At the time of our inspection there were 21 people using the service.

A registered manager was in post at the service. 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.

When we last inspected we found staff were not supported to have the necessary skills to assist people to move and transfer safely. In addition, the provider had not supported the manager to minimise risk and drive improvements at the service.

At this visit we found the provider had worked well with the manager to improve systems and communication. People and their families felt valued by the investment in the service. All senior and care staff had received improved training in how to safely move people.

The manager was exceptional. They ensured people were central to the service and used effective systems to ensure the service was constantly improving.

Risk was well managed at the service. People were protected from the risk of abuse and staff knew what actions to take if they were concerned about people’s safety. There were sufficient numbers of safely recruited staff to meet people’s needs and preferences. People were supported to take their prescribed medicines safely. The provider had a safe recruitment process in place to protect people from the risk of avoidable harm.

Staff supported people to have enough to eat and drink and to have input into meal planning. People were supported to stay healthy and to access health services as required.

The service was meeting the requirements of The Mental Capacity Act 2005 (MCA). Assessments of capacity had been undertaken and applications for Deprivation of Liberty Safeguards (DoLS) had been made to the relevant local authority. People were supported effectively to make their own decisions about their care and daily routines.

Staff communicated well with people well to ensure they had a say about the care they received. People were treated with respect and dignity. Staff knew people well and could describe their personal preferences and preferred routines. People’s needs had been assessed and care was personalised. Activities were flexible and varied.

People and their families were encouraged to provide feedback in a number of ways to ensure their views were central to the service. Complaints and concerns were addressed and responded to thoroughly and any learning led to improvements.

The inspection took place on 12 January 2016 and was unannounced.

Squeaks House provides personal care and accommodation for up to 29 older people, primarily those living with dementia. The service does not provide nursing care. At the time of our inspection there were twenty people using the service.

A registered manager was in post at the service. 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.

Staff were not supported to have the competence, skills and experience to provide safe care and support when assisting people to move and transfer safely.

The manager had carried out detailed audits and developed detailed improvement plans highlighting risks within the service; however these had not been implemented effectively by the provider. There was a visible and committed manager who listened to people and staff and involved them in the service.

The service had appropriate systems in place to keep people safe. Staff knew how to recognise when people might be at risk of harm and what actions to take. There were sufficient numbers of staff available to meet people’s care needs. There were systems in place to manage medicines and people were supported to take their prescribed medicines safely. The provider had a robust recruitment process in place to protect people from the risk of avoidable harm.

Staff supported people to have sufficient food and drink and staff spent time finding out what people’s preferences were. People were supported to maintain good physical health and access health services.

Deprivation of Liberty safeguards (DoLS) had been appropriately applied for. These safeguards protected the rights of adults who used the services and who do not have capacity to make their own decisions. Applications had been made appropriately for people who may require them. Appropriate assessment and authorisation by professionals had been completed, for any best interest decision taken regarding any restriction on their freedom and liberty. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice.

Staff listened to people and treated them with compassion. Communication between staff and people using the service was respectful. Staff knew people well and could describe their personal preferences and preferred routines. People’s needs had been assessed and personalised care plans were in place to inform staff how to support people in the way they preferred. People were supported to pursue individual interests and hobbies and had access to a range of activities.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.

People were happy living at Squeaks House. They told us that the staff team were friendly and that their dignity was respected. Comments included: "I have settled in well here, the staff are kind and when I use my buzzer they come." From feedback surveys sent out by the home we found that relatives were happy with the standards of care provided at the home. Overall care management was good and people's needs were met but more could be provided in the way of social care and care records could improve further.

We found that staff were appropriately trained and supervised and that the provider had systems in place to assess and monitor the quality of care at the home.

We used the Short Observational Framework for inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. We found that people were in positive moods and interacted with staff well and were not withdrawn.

Due to cognitive impairment and disorientation to time and place, there was limited discussion with the people who use the service.

People said that they were quite happy at the home and with the care provided. People also said that they enjoyed the food at the home.

Due to the presence of cognitive impairment and disorientation to time and place for a number of people living in the home, discussion with the majority of people using the service was limited. However, the people with whom we spoke said that they were comfortable. One person said that they had a coffee but no squash was left in their bedroom room as there was a problem with ants. Care workers confirmed that the problem with the ants was being appropriately treated. Another person said that they had enjoyed their lunch and that they had been able to choose their meal.

Due to cognitive impairment and disorientation to time and place there was limited discussion with the people who use the service.

The mealtime was not seen to be an enjoyable and social event for people. The people with whom we spoke said that they had enjoyed the pudding.

Observation of their body language, expression and interaction between other residents and the staff demonstrated that people were comfortable and relaxed.

Due to cognitive impairment and disorientation to time and place, there was limited discussion with the people who use the service.