This inspection was carried out on the 12 October 2017 and was unannounced. We last inspected Stuart House in September 2015. At the last inspection we rated the service overall Good with requires improvement for the key question "Is the service effective."

We recommended that the provider considered specific dementia awareness training for staff, improve signage and other memory aids to assist people living at Stuart House with stimulation and recognition. At this inspection we found improvements had been made. We found the service remained Good overall.

Stuart House is a care home which provides accommodation for up to 19 people. The service supports older people, some of whom may be living with dementia. The service is located in Hornsea, a seaside town in the East Riding of Yorkshire. At the time of our inspection there were 19 people using the service.

There was a manager in post who had registered with the Care Quality Commission in May 2017. 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 told us the care workers were kind and caring. One person said, “I would be lost without them. They are very kind.”

Care workers knew how to keep people safe and understood their duty to protect people from the risk of abuse. Risks were managed so that people were protected from avoidable harm.

There were enough care workers to keep people safe. Appropriate checks were undertaken to ensure newly recruited care workers were safe to work with people using the service.

Medicines were managed safely and people received them as prescribed.

There were records of essential maintenance and inspections by specialist contractors. Fire safety arrangements were in place. The environment was kept clean and tidy. Infection control measures were in place.

Care workers received relevant training and were supported by senior staff to help them meet people's needs effectively.

We found that the Mental Capacity Act 2005 and the Deprivation of Liberty (DoLS) 2009 legislation had been adhered to. The registered manager was able to tell us of the people at the service who lacked capacity. We found appropriate DoLS applications had been submitted to the local authority in relation to people's care.

People’s dietary needs had been assessed and arrangements were in place to ensure that people received adequate nutrition. People were satisfied with the meals provided.

The service worked with health care professionals to ensure that people's healthcare needs were met.

People told us they were happy with the activities organised at Stuart House.

Care workers understood people's individual needs in relation to their care. Care plans were in the process of being improved so they were centred on the person and reflected individual's preferences.

There was a complaints procedure for people to raise their concerns.

The registered manager used a selection of methods to assess and monitor the quality of the service. These included surveys and regular audits. Staff and resident meetings were held to seek their views about the service and their opinions to make improvements.

Further information is in the detailed findings below.

This inspection took place on 2 September 2015 and was unannounced. We previously visited the service on 27 August 2013 and we found that the registered provider met the regulations we assessed.

The service is registered to provide personal care and accommodation for up to 19 older people, some of whom may be living with dementia. On the day of the inspection there were 17 people living at the home. The home is located in Hornsea, a seaside town in the East Riding of Yorkshire. It is close to town centre amenities and the sea front, and is on good transport routes.

The registered provider is required to have a registered manager in post and on the day of the inspection there was a manager registered with the Care Quality Commission (CQC); they had been registered since 4 December 2014. 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 told us that they felt safe living at Stuart House and we saw that the premises had been maintained in a safe condition.

We found that people were protected from the risks of harm or abuse because the registered provider had effective systems in place to manage any safeguarding issues. Staff were trained in safeguarding adults from abuse and understood their responsibilities in respect of protecting people from the risk of harm.

Although managers and some staff had completed training on the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), the registered manager needed to be prompted to submit applications to the local authority in respect of some people who were possibly being deprived of their liberty. People were supported to make their own decisions when they had capacity to do so, and best interest meetings were held when people did not have the capacity to make decisions for themselves. However, best interest meeting records were not specific about the decision being made.

Staff confirmed that they received induction training when they were new in post and told us that they were happy with the training provided for them. The training records evidenced that most staff had completed training that was considered to be essential by the home and that most staff had achieved a National Vocational Qualification (NVQ).

New staff had been employed following the home’s recruitment and selection policies to ensure that only people considered suitable to work with older people had been employed. We saw that there were sufficient numbers of staff on duty to meet people’s individual needs.

Staff who had responsibility for the administration of medication had completed appropriate training. Medicines were administered safely by staff and the arrangements for storage and recording were robust, although some minor improvements were needed.

People’s nutritional needs had been assessed and people told us that their special diets were catered for, and that they were happy with the meals provided at the home. We saw there was a choice available at each mealtime, and that people had been consulted about the choices available on the home’s menu.

People told us that staff were caring and we observed that staff had a caring and supportive attitude towards people; this was supported by the relatives and care professionals who we spoke with.

There were systems in place to seek feedback from people who lived at the home and relatives / visitors. There had been no formal complaints made to the home during the previous twelve months but there were systems in place to manage complaints if they were received.

People who lived at the home, relatives and staff told us that the home was well managed. The quality audits undertaken by the registered manager were designed to identify any areas that needed to improve in respect of safety and people’s care. However, more effort could have been made to analyse the outcome of audits and surveys so that there was a record of the improvements that had been made.

We saw that, on occasions, incidents that had occurred at the home had been used as a learning opportunity for staff.

We spoke with the deputy manager, staff, two people who lived at the home and a district nurse.

We found that people were supported by staff in a positive and encouraging way. People who lived at the home told us that staff were caring and attentive. Care plans were reviewed and updated on a regular basis so staff had up to date information to refer to. People were asked to confirm their consent to having a photograph taken, to staff administering their medication and to being weighed as part of nutritional screening.

Medicines were handled safely and stored securely. Some minor improvements in recording were needed to provide a more robust record of medicines administered.

Staff received appropriate training and told us that they were well supported by the management team.

There were quality monitoring systems in place that gave people the opportunity to comment on the care they received although some areas required improvement. There was a complaints policy in place and staff told us that they would encourage people to complain if they expressed any concerns about the care they had received.

We used a number of different methods to help us understand the experiences of people who used the service, because they had complex needs which meant they were not able to tell us their experiences.

We chatted to people who lived at the home and we observed the interaction between them and staff. We saw positive interactions and it was clear that staff understood the individual needs of the people they supported.

Prior to the site visit we had spoken to the local authority and they told us that the manager made appropriate referrals to the safeguarding adult’s team.

We observed positive communication between visitors to the home and staff. During our visit to the home a relative called in – they brought cream cakes for their relative and for staff. They said to staff, ‘you deserve it’.