Staverton House is a purpose built two storey care home, registered to provide personal care and accommodation for up to 20 older people living with dementia. The service is part of Equality Care Limited; a provider of other care home services in Wiltshire. At the time of our inspection 20 people were living at the home.

The inspection was unannounced and took place on the 29 November and 5 December 2016.

The service had a registered manager who was responsible for the day to day running of the home. 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 comprehensive inspection in September 2015 we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA), when people lacked the capacity to give consent to receiving care at Staverton House. Sufficient numbers of staff were not consistently deployed to fully meet people’s needs and the service did not always provide care in a safe way by taking all reasonably practicable measures to mitigate risks.

At this inspection we found that the provider had taken action to address the issues highlighted in the action plan. We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly undertaken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

Staffing levels had improved. There were enough staff on duty to meet people’s care and support needs safely. Staff were visible at all times. Risk assessments were in place to support people to be as independent as possible. Risks to people’s personal safety had been assessed and plans were in place to minimise these risks.

People appeared happy in their surroundings and the home was decorated to support people living with dementia in maintaining as much independence as possible. Individualised memory boxes were in place on people’s bedroom doors as well as appropriate signage to help them find their way around the home. Relatives spoke positively about the care and support their family member received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly.

People were treated with dignity and their right to privacy was respected. Staff knocked on people’s doors before entering and sought people’s permission before undertaking any care tasks. We found staff had a good understanding of people’s needs, interests, likes and dislikes. We observed a range of positive and caring interactions during our inspection.

People were supported to have sufficient food and fluids. People were offered a choice at meal times and where people did not want what was on the menu alternatives were available.

People’s medicines were managed safely. Systems in place ensured that people received the medicines as prescribed and at the correct time.

There were systems in place which encouraged people and their relatives to share their views on the service. Complaints were investigated and responded to appropriately. People also had an opportunity to share their views and make suggestions at the monthly residents’ meeting.

Staff displayed a good understanding of how to keep people safe from potential harm or abuse and what actions they would take should they suspect abuse had taken place.

Safe recruitment practices were followed before new staff were employed to work with people. Checks were made to ensure staff were of good character and suitable for their role. The staff had received appropriate traini

On the day of the inspection there were 18 people living in the home. We spoke with three relatives, two people using the service and five care staff. We did not ask people many questions as they were not able to fully understand what we were asking due to a cognitive impairment. Instead we spent time observing how staff communicated and supported people to see people's experiences of care in the home.

Relatives we spoke with were satisfied with the care provided for their family member. One relative said "I can’t fault them (staff). It’s excellent; it’s not put on for us. The care they give is amazing!” Another relative told us “my mother has been much better since she has been here. They know the people they are looking after.” One person we spoke with told us “it’s very nice. They’re kind.”

We observed staff were patient and kind. They communicated effectively and provided support and activities to promote awareness for the person with dementia.

People were supported to eat safely and with dignity. The menu was varied and people's choices were accommodated.

We found people's medicines were administered and managed safely.

Staff records were easy to follow and included a checklist of information and documentation received in order to ensure the appropriate security checks.

Overall people's care records contained sufficient information for staff to provide safe, effective care. People's monitoring charts were not always accurately completed.

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 saw overall the provider was following the Department of Health’s Code of Practice on the prevention and control of infection (2008). They had addressed previous shortfalls in their processes to ensure people were cared for in a clean environment and cross infection risks were reduced. Care staff had received regular training about the principles of preventing cross infection. They were knowledgeable about their role in reducing cross infection risk.

People's plans of care were updated as their care needs changed. People's monitoring charts were maintained and updated as required. The provider had a system to monitor the completion of people's daily monitoring charts.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke with a GP and a district nurse. We observed care and spoke with members of staff about people's needs.

People were receiving appropriate care and support, but this was not always fully recorded. Two healthcare professionals said they found people were well supported by members of staff who were knowledgeable about people’s care needs.

Decisions had been made about resuscitation without capacity assessments or best interest meetings had not been recorded.

Members of staff engaged with people in a respectful and friendly manner.

Members of staff had access to a range of training, but the records did not always show when this was completed.

Infection control guidance had not been implemented.

The manager was auditing the services and facilities to look at how things could improve.

Staverton House is a purpose built two storey care home service, registered to provide personal care and accommodation for up to 20 older people living with dementia. The service is part of Equality Care Limited; a provider of other care home services in Wiltshire. At the time of our inspection 20 people were living at the home.

The inspection was unannounced and took place on the 30 September and 1 October 2015.

The service had a registered manager who was responsible for the day to day running of the home and had been in post for approximately 18 months. 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 service did not follow the requirements set out in the Mental Capacity Act 2005 (MCA) when people lacked the capacity to give consent to receiving care at Staverton House.

The MCA sets out what must be done to make sure that the rights of people who may lack mental capacity to make decisions are protected in relation to consent or refusal of care or treatment. CQC is required by law to monitor the application of the MCA and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. This includes decisions about depriving people of their liberty so that they get the care and treatment they need where there is no less restrictive way of achieving this. DoLS require care home providers to submit applications to a ‘Supervisory Body’; the appropriate local authority, for authority to do so. All necessary applications for people living at Staverton House had been submitted.

Sufficient numbers of staff were not consistently deployed fully to meet people’s needs.

Reporting and recording of incidents and accidents took place. There was an effective system for auditing incidents and accidents that was used to improve the quality and safety of the service.

Medicines were safely managed and people were helped to access health services when necessary. We found the service did not have individual protocols in place to guide staff on how diabetes should be effectively monitored and we have made a recommendation about this.

People said they felt safe living at the home. Staff were aware of their safeguarding responsibilities and showed positive attitude to this, and also to whistleblowing.

The premises were safe, clean, homely and well maintained however; we found dirty chairs were stored in the downstairs bathroom.

One relative commented on the happy atmosphere in the home and how staff were often smiling and singing. Relatives we spoke with expressed a very high level of satisfaction with the service provided at Staverton House. One relative said, They show a very high level of commitment to the care they provide,” another described the home as, “Wonderful.” People were also complimentary about the food provided at the home.

There were effective management systems in place that provided staff with clear lines of responsibility and accountability. The service had systems to keep staff up to date with best practice and to drive improvement and promote safety.

There was a complaints procedure in place; the service investigated complaints and responded in a timely way. The service routinely sought and acted on feedback and comments from people and those who were important to them.

Staff acted in a caring manner; we observed they treated people with respect, and asked before carrying out care. People who use the service were helped to make choices and decisions about how their care was provided. One person said that staff were respectful. Another said, “the staff are good, they are helpful and kind.”

Each person who uses the service had their own personalised care plan which promoted their individual choices and preferences. People were assisted to go out into the community to enjoy leisure time and also to attend health appointments.

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