We inspected this service on 23 June 2017. The inspection was announced and arranged to inspect the service following a fire at the home on 16 April 2017. Due to the fire and water damage the provider had worked with the local authority for people to move to other homes in the area. There were no people receiving a service at the time of our inspection visit and this inspection visit was to view the premises to ensure it was suitable and safe for people to start using a service.

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.

The provider had completed the work necessary to enable people to move into one part of the home. They had worked with relevant authorities and furnishings had been deep cleaned, new carpet and bathroom facilities had been installed and rooms redecorated. New fire systems had been installed and assessments of risk completed to ensure people’s safety.

The registered person will amend their registration to reflect how many people could be accommodated in the home following the completed work. At the time of the inspection, this meant the home would be able to accommodate 13 people.

We inspected this service on 8 December 2016. The inspection was unannounced. At our previous inspection in January 2016 we rated the service as requires improvement as there were specific concerns with how some people had complex needs received care, how medicines were managed and how people were supported to make decisions. The provider sent us an action plan on 29 February 2016 which stated how and when they would make improvements to meet the legal requirements. On this inspection we saw improvements had been made.

The service provides accommodation and personal care for up to 31 older people who maybe living with dementia. There were 30 people were living at the home on the day of our 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.

Where people lacked capacity to make certain decisions, these were now made in consultation with people who were important to them and made in their best interests. Restrictions had been identified and applications had been made to ensure these were lawful.

Where people needed additional support because they had complex needs, there were plans in place to guide staff how to respond to keep them and others safe. Staff understood what to do to reduce any risk.

Medication systems had been reviewed and were now managed safely to ensure that people received their medicines as prescribed. Medication audits were completed and could easily identify if there were any errors so suitable action could be taken as required.

People were involved in planning and agreeing how they were cared for when they moved into the home. However, where care was reviewed, people were not involved to ensure it reflected their views and continued to meet their needs. People had mixed views about how they were supported to pursue their interests as arrangements were not always in place to promote activities in the home or when out.

Staff understood their responsibilities to protect people from harm and knew how to raise concerns. Risks to people’s health and welfare were assessed and staff knew how to minimise the identified risks. The premises were regularly checked to ensure risks to people’s safety were minimised.

There were sufficient, suitably recruited staff to meet the support needs of people and staff understood their role. People’s needs were met effectively because staff received training and support to enable them to meet their needs. The staff received support from their manager to enable them to identify personal development opportunities and to raise any concerns they had. People felt well looked after and had developed good relationships with staff.

People were offered meals that they liked and were supported to eat and drink according to their needs. People were cared for by kind and compassionate staff who knew their individual preferences for care and their likes and dislikes. Staff ensured people obtained advice and support from other health professionals to maintain and improve their health.

The provider’s quality monitoring system included consulting with people and their relatives to ensure planned improvements were focussed on people’s experience. Quality audits included reviews of people’s care plans and checks on medicines management and staff’s practice. Accidents, incidents, falls and complaints were investigated and actions taken to minimise the risks of a re-occurrence.

This inspection took place on 11 January 2016 and was unannounced. Our last inspection took place in November 2013 and at that time we found the provider was meeting the regulations we looked at.

Standon House provides residential care for up to 31 older people who may be living with dementia. At the time of our inspection 26 people were receiving a service.

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.

Some people had complex needs and the support they received had not been reviewed to ensure they were supported to keep safe. Support plans did not include information about how staff should manage incidents where people may place themselves or others at harm.

People’s medicines were not always managed in a safe way as some tablets needed to be halved. The systems in place meant this may not be done by the best method. Some tablets were not stored in a way to ensure they were safe to administer. Medicine audits did not accurately reflect the number of tablets that were stored to determine that people received their medicines as prescribed.

People chose how to spend their time and staff sought people’s consent before they provided care and support. However, some people did not have capacity to make certain decisions. It was not clear how some decisions had been made and whether people should make the decision for themselves. We saw some people may have had restrictions placed upon them as they were not able to go out alone and may not have the capacity to make a decision about their safety. Applications to ensure these restrictions were lawful had not been made for all these people.

Systems were in place to assess and monitor the quality of the service. However, the provider had not identified where improvements could be made to ensure people received care to support their complex needs; when people no longer had capacity, how they were supported to make decisions and how medicines were managed. We had not received all notifications about people’s safety that were required of a registered person.

Staff had a good understanding and knowledge of safeguarding people and understood what constituted abuse or poor practice. Where harm or abuse was suspected, the staff knew how to respond to protect people.

People liked the food that was prepared and they had a choice about what they ate and drank. People were offered a variety of food and drink throughout the day. Specialist diets were catered for and alternative meals could be provided upon request. People received support to remain independent at meal times and where they needed support, this was done in a caring and supportive way.

There were sufficient staff to meet people’s needs and people were cared for and supported by staff who knew them. The staff were kind and treated people with dignity and respect. The staff understood the importance people placed on their possessions and enabled them to look after what was important to them. People were confident that staff supported them in the way they wanted. Staff knew people and their family well and family members were encouraged to remain part of people’s lives.

People were supported to attend healthcare appointments and received care from other healthcare professionals as required to meet their needs.

People who used the service, their relatives and the staff were complimentary about the registered manager and provider of the service who was accessible and approachable. People were able to formally comment on the quality of the service and people had reported positively on the care and support they had received during this annual review.

People knew how to make complaints. They were conf

When we inspected Standon House in July 2013, we observed people being treated with consideration and respect. We saw evidence that their right to privacy was respected and that their right to independence was supported as much as possible. People appeared content and told us positive things about the home. One person told us: “Oh yes, I enjoy my breakfast, especially my toast and marmalade”. Another person said: “I do like getting my hair done”.

We saw that work had been undertaken to make people’s care plans personalised, detailed and specific. We saw that care delivery followed the care plans.

Staff told us they were well-supported by their managers at Standon House and we saw evidence of this in the supervision records we looked at and in records of staff meetings.

The quality of the service provided was monitored by managers through their contact with the people who used the service, staff supervision and ensuring that they were available for discussion with people’s families and professional visitors.

We looked at the administration of medicines in the home with one of the care managers. We found that an error had occurred while we were there. It was managed to ensure the person who had missed a medicine was not at risk. We checked a range of medication records and found no other evidence of errors made.

When we inspected Standon House in August 2012, we asked the provider and registered manager to develop some parts of the service they provided. The provider sent us a comprehensive action plan which explained how they were making changes so that people received improved levels of care. We returned to Standon House in November 2012 to follow up these actions.

There were new policies to promote the dignity of people who shared a bedroom and to demonstrate respect for people through the use of appropriate language. The management team had introduced a new format for care plans. We saw that these were person-centred and gave appropriate details for care workers to understand people’s needs. A new office had been established which provided improved storage for people’s records. We found that systems for quality assurance and for keeping people safe had been extended.

We saw that there were enough staff to give each person the assistance they required including the people who stayed in their rooms. The updated training matrix clarified that every staff member including the manager and deputy manager had completed appropriate training.

The people who lived at Standon House could not tell us how they viewed their care. We spoke with the relatives of three people. They told us the staff were considerate and respectful. They said staff were mindful of their relatives’ dignity and sought to maintain this. One visitor described their relative as “happy” at Standon House.

When we visited Standon House, one person told us she was happy with her life there. Most people were unable to describe their experiences. We asked the relatives of three people about the care at Standon. Two relatives were happy with the care provided; one relative had some concerns about the level of staffing at the home.

We had concerns about the care people received. Their dignity and privacy was not always respected. Care planning was not personalised or thorough and care workers did not use care plans to ensure they cared for people in ways that met their needs. We could not be certain that the potential for safeguarding incidents was recognised. Nor was it clear that there were always enough care workers to meet the needs of every person who lived at the home.

We had particular concerns that the registered manager delegated many of the manager's responsibilities and did not satisfy himself that the quality of care provision was high. There was a lack of systems to monitor the quality of care. The registered manager had not ensured that his own knowledge of current care practices and legislation was updated through training. Record keeping was not well-organised.