This inspection took place on 11 and 12 May 2017 and was unannounced. We carried out this inspection because we found one breach of regulation at the last inspection carried out on 19 April 2016. The provider sent us an action plan which we reviewed during this inspection.

Stokeleigh is registered to provide personal care and accommodation for up to 30 people. The home specialises in the care of older people, some of whom are living with dementia. At the time of our inspection there were 24 people living in the home.

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 of the Health and Social Care Act 2008 and associated Regulations about how the home is run.

The registered manager and staff understood their role and responsibilities to protect people from harm. Staff had received training in how to protect people from abuse. The risks to people had been assessed, recorded and plans implemented to manage these.

Staffing levels ensured people's needs could be met safely.

Staff recruitment procedures were safe and the employment files contained all the relevant information to help ensure only the appropriate staff were employed to work at the home.

People received their medicines when they required them and in a safe manner. Staff received training and guidance to make sure they remained competent to handle people's medicines.

The home was meeting the requirements of the Deprivation of Liberty Safeguards. Staff had received appropriate training, and had a good understanding of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Staff received appropriate training and support to ensure they had the knowledge and skills needed to perform their roles effectively.

People were supported to eat and drink enough to meet their dietary needs and preferences. They also received the support they needed to stay healthy and to access healthcare services.

Staff knew the people they supported and offered care in kind and compassionate ways. People's dignity was maintained and staff gave people the time they needed when speaking with them. People were involved in decisions about their care and extra support was available should this be required. People were supported to maintain their independence.

The registered manager promoted an open and inclusive culture within the home. People and their relatives felt the home was well managed. Staff felt well supported and were clear what was expected of them.

The registered manager assessed and monitored the quality of the service provided for people. Systems were in place to check on the standards within the home. These included regular audits of care records, medicine management and health and safety.

We undertook an unannounced inspection of Stokeleigh on 19 April 2016. When the service was last inspected in April 2015 there were three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 identified. We found procedures for preventing the risk of cross infection were not always followed. People had not always been protected from the risks associated with medication. People’s rights had not always been fully protected in line with the Mental Capacity Act 2005 and people’s healthcare needs were not always effectively met. These breaches were followed up as part of our inspection.

Stokeleigh provides accommodation and personal care for up to 30 older people, some of whom are living with dementia. At the time of our inspection there were 28 people living at the home.

A registered manager was in post at the time of 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 said they felt safe living at Stokeleigh. Medicines were managed and administered safely following the home’s procedures and individual protocols. The action taken by the home following the last inspection in April 2015 ensured that improvements had been made. Safe recruitment procedures were in place and new staff completed a full induction aligned with the Care Certificate. Staff received regular training to ensure they were skilled and effective in their roles. We did highlight that specific training relating to particular needs of people, for example those living with diabetes would be beneficial.

Staffing levels were sufficient to be safe. However, staffing levels did impact on the amount of support available to people during mealtimes, for personal care and in accessing the community.

Staff understood the principles of the Mental Capacity Act 2005 and applied these in their role. Best interest decisions, when needed, were made in accordance with guidelines and with involvement from families and health and social care professionals. Applications were made when appropriate in relation to the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to approve the deprivation of liberty for a person when they lack the capacity to consent to treatment or care or need protecting from harm. However, we found that the conditions set out in people’s DoLS authorisations were not always being met.

People’s healthcare needs in relation to hydration and nutrition which had not previously been met were now identified and monitored. Information was recorded and areas of concern communicated to staff. When needed, further involvement from healthcare professionals was sought.

The feedback from people was positive about the care they received and the staff at the home. We observed staff being kind, attentive and treating people with dignity and respect. People’s visitors were welcomed at the home. However, people could not always enter the home in a timely manner.

The home provided a range of activities and we observed people participating and enjoying themselves. However, some feedback suggested people lacked stimulation and people said they wished to go out more.

Care plans were personalised. They were well organised and accessible to people. Feedback was sought from people, relatives and staff through meetings and questionnaires.

People and staff told us the home was well-led and managed. The home had systems in place to monitor the quality of care.

We found one breach 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 this report.

The inspection took place on 2 April 2015 and was unannounced. The service had no breaches of regulation at the last inspection in October 2013.

The home provides accommodation and personal care for up to 30 people, some of whom are living with dementia. There is a registered manager in place at 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.

People did not always receive safe support with their medicines. For example, there was inconsistent information in one person’s support plan about how their PRN medicine should be used. We also noted that best practice in infection control was not always followed during administration of medicines.

The principles of the Mental Capacity Act 2005 were not yet embedded into practice where decisions needed to made on behalf of people who lacked capacity. A relative had been asked to give their consent to the use of bedrails for a person, which is not in line with the requirements of the Act. Not all staff were clear about the principles of the act which meant there was a risk that people’s rights would not be fully protected.

People’s healthcare needs were not all effectively met. For example, we found person who was at risk of malnutrition but there was no care plan in place to describe how this risk should be minimised. Where food and fluid charts were in use, amounts of fluid taken each day were not totalled which meant that people’s intake was not being effectively monitored.

Feedback from people in the home was positive and this was reflected in the feedback from relatives also. There was a programme of activities in place and we observed people taking part in these during our inspection.

Staff were kind and caring in their approach and we observed staff offering kindness and reassurance when a person became upset. People had opportunity to be involved in care planning and gave their opinions and views when support was reviewed. Relatives told us they felt welcomed in the home and were kept informed of any important developments.

There were arrangements in place to meet people’s individual needs and preferences. This included a document entitled ‘this is me’, which gave details about a person’s life before they moved to the home. People confirmed they were able to follow their own routines, for example by choosing when they wanted to go to bed and to get up.

Staff were positive about the training and support they received. We reviewed the training matrix which showed the majority of staff were up to date with relevant training. Topics included moving and handling, safeguarding and dementia.

There was an open culture within the home and staff felt confident about raising any concerns or issues. Staff understood the term whistle blowing and their responsibility to use this procedure to protect people in the home if they needed to.

There were systems in place to monitor the quality and safety of the service and this included gathering the views of people in the home and their relatives.

We found three breaches of regulation during our inspection. You can see the action we have asked the provider to take at the end of the full version of this report.

Every person we spoke with had positive opinions about the staff who worked in the home, people told us “they treat me really well” and “everyone is so kind”.

We spoke with nine people who used the service, examples of comments people told us included “I am very happy here” and “I am very contented here”.

The people we spoke with told us “the food is lovely here” and “there is always plenty of food and you can have seconds if you want”. People were provided with a varied and nutritious diet.

We found that care plans were sufficiently detailed and gave staff guidance about how to support people in the home in a person centred way. These were regularly updated to reflect people’s current needs.

There were systems in place to monitor the quality of the service people received and this included gaining feedback from people who used the service.

People told us that the home was meeting their needs. They spoke positively about the care they received and about their relationships with staff. One person for example said “they look after me very well” and another person told us that staff did “their best to keep us active”.

People said that they felt able to discuss any concerns with the manager or staff if they needed to. One person commented that the manager was “approachable” and that all the staff were “very nice”. A complaints procedure was displayed in the home which included details of the further action that people could take if necessary.

There was a recruitment process which helped to ensure that new staff were suitable for the work and safe to work with people at the home. Staff received training and guidance about abuse so that they were aware of the risks to people and they knew what to do if they had any concerns.

When we asked people who live at Stokeleigh about staff and about the support they received the people we spoke with were complimentary. One person said the staff were “Very gentle and understanding”. The five people we spoke to also told us the staff were lovely and they felt safe and respected. One relative told us,“I’d book a room here”.

We spoke to four staff who told us they were happy working at Stokeleigh and really enjoyed their work.