About the service: Strawberry Fields Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This service supports older people. At the time of the inspection there were 40 people using the service.

People’s experience of using this service:

• The provider met the characteristics of ‘Good’ in all areas. This has improved from a rating of ‘Requires Improvement’ at the last inspection in 2018. More information about this is in the full report.

• The risks to people’s health and safety were now appropriately assessed resulting in safe care being provided. Improvements had been made to the way people’s medicines were managed. People were protected by staff who understood how to protect them from avoidable harm. The provider had acted on a recommendation made by the CQC at the last inspection to review the deployment of staff. Improvements in this area meant staff were now available for people when they needed them

• The risk of the spread of inspection was safely managed, although we did identify one piece of equipment and one room that required cleaning. Systems were in place to help the provide to learn from mistakes. This included the detailed analysis of accidents and incidents.

• People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

• Staff training was largely up to date and they received on-going assessment of their practice. People were provided with care and support which protected them from discrimination. People received the support they needed to maintain a healthy diet. People at risk of weight loss or gain and dehydration were referred to health specialists. People had access to other health and social care agencies where needed. The environment had been adapted to support people living with dementia and/or a physical disability.

• People found the staff to be kind, caring and respectful. People were treated with dignity and their independence was encouraged. People felt involved with decisions and that staff respected their wishes. People’s records were stored securely to protect their privacy.

• Improvements had been made to the way people’s personal preferences and choices were used when care was planned for them. Improvements had been made to the activities provided with people now having a wider range of meaningful activities available to them.

• People’s needs were assessed prior to them coming to live at the home. This helped to ensure their needs could be met by staff. People’s personal preferences were considered when care was planned. People had access to information in a format they could understand. Complaints were responded to in line with the provider’s complaints policy. People were not currently receiving end of life care. End of life care plans were basic and required more detailed reference to people’s personal preferences.

• Improvements had been made to the overall assessment of risk at the home. Audits were now effectively used to assist the registered manager and the provider in identifying and acting on risks in an effective and timely manner. People, relatives and staff praised the approach of the registered manager. Staff found her to be welcoming and they felt respected and valued. Relatives had been given the opportunity to give their views about how the service could develop and improve. Plans were in place to provide people living at the home the same opportunity.

• There was now continued focus on learning, development and improvement. The registered manager had a good understanding of the regulatory requirements of their role.

Rating at last inspection:

At the last inspection the service was rated as Requires Improvement (25 January

We inspected the service on 25 January 2018. The inspection was unannounced. Strawberry Fields Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Strawberry Fields accommodates up to 45 people in one building. On the day of our inspection, 35 people were living at the home, all of these were older people, some of whom were living with dementia. This was the first time we had inspected the service since they registered with us.

There was a registered manager 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.

During this inspection, we found the service was not consistently safe. People were at risk of not receiving their medicines when needed, as there were not always trained staff available to administer medicines. We also found other issues with the management of medicines, which placed people at risk of not receiving their medicines as required.

People were not always protected from risks associated their care and support. Risks were not always identified and addressed in a timely manner and this placed people at risk of harm. Risk assessments were not always sufficient and guidance in place to reduce risks was confusing and resulted in inconsistent practice in some areas. There were enough staff employed, however staff were not always deployed effectively to meet people’s needs and ensure their safety. Adequate steps had not always been taken to ensure people were protected from staff that may not be fit and safe to support them. There were systems and processes in place to minimise the risk of abuse and incidents were investigated thoroughly. The home was clean and hygienic.

Where people had capacity to make decisions they were asked for their consent by staff. However, where people lacked capacity their rights under the Mental Capacity Act (2005) were not respected at all times. Overall, people were supported by staff that had the skills and knowledge to provide good quality care and support.

People were not always protected from the risk of poor food and fluid intake as monitoring systems were not effective. People provided mixed feedback about the quality and quantity of food served at the home. People were supported to attend health appointments. However, there was a risk people may not receive appropriate support with specific health conditions as care plans did not consistently contain sufficient information for staff to follow. There were systems in place to ensure information was shared across services when people moved between them, however these were not always effective. People’s diverse needs had been taken into account in the design and decoration of the building.

People told us staff were kind and caring but commented staff did not have time to spend with them. We observed interactions were limited and task focused. People’s right to privacy was not always respected. People were not consistently provided with information in a way that was accessible to them and staff did not always demonstrate an understanding of how people communicated. People told us they were involved in decisions about their care and support, however we found this was not always the case. People had access to advocacy services if they required this.

People were at risk of receiving inconsistent support, as care plans did not all contain accurate, up to date information and staff did not always follow the guidance in care plans. People’s social and recreational needs were not met as there were very limited oppo