This inspection visit was unannounced and took place on 7 March 2017. At our last inspection visit on June 2015 we asked the provider to make improvements to the staffing in the communal areas of the home. At this inspection, we found improvements had been made. The service was registered to provide accommodation for up to 61 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 58 people were using the 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 home had enough staff to support people’s needs and they were deployed to ensure people received support when they needed it. The staff - employed had received a range of checks to ensure they were suitable to work in the home. People were supported to make choices, and - assessments reflected the person’s level of understanding in different situations. The manager and provider had established a range of audits to monitor improvements within the home. We saw feedback was sought from people, relatives and professionals and any areas raised had been considered and responded to.

We found staff had established positive relationships with people. Staff showed respect for people’s choices- and supported them to maintain their privacy and dignity at all times. People were able to choose the meals they wished to eat and alternatives were provided. We saw that medicines were managed safely and administered in line with people’s prescriptions and preferences. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff obtained information from the person and their relatives to support the completion of the care plan. People were encouraged and supported with activities or hobbies they wished to engage in.- c-Complaints had been addressed and resolved in a timely manner.

Staff felt supported by the manager and there was a clear process in place to cascade information to staff about the service and the needs of people. Staff had received training and the provider had invested time to expand the staff knowledge in end of life care which was provided in a dignified and respectful way.

We saw that the previous rating was displayed in the reception of the home - and on the provider’s website as required. The manager understood their responsibility of registration with us and notified us of important events that occurred at the service; this meant we could check appropriate action had been taken.

We spoke to twelve people using the service and four people’s visitors. Everyone confirmed that staff were friendly and attentive to their needs. Comments included, “the staff here are very good, I can’t complain about them at all, they do a very good job.”

Some people told us that over recent weeks there had been a shortage of staff in the cedars unit, this had led to them having to wait longer than usual for staff support. The registered manager had taken action to cover gaps in shifts and additional staff were in the process of being recruited.

Care records demonstrated that people’s support needs had been identified and information was in place regarding people’s preferences and interests, including their life history, this supported staff in providing holistic care to each person. Staff spoken with had a good understanding of people’s needs.

People’s care plans included information about their ability to make day to day decisions regarding their life and their capacity to consent.

A variety of activities were available for people to participate in.

People spoken with had mixed views on the meals provided. The majority of people told us they enjoyed the meals, others thought there was not enough variety in the choices available.

Medicines were managed appropriately, this ensured people received their prescribed medication in a safe way.

We spoke to 11 people and 11 relatives. Two people told us that they preferred to stay in their rooms, as they had lived alone before moving into the home and liked their own company. One person said, “I go downstairs for meals, to have a chat with folks and if there’s something going on that I want to join in with, but otherwise I like to be in my own room and watch TV.”

People were able to move around the home and grounds freely and this was observed during our visit. One person told us that they were able to go out with staff support when they wanted to. They said,” I like to walk over to the library and sit on the bench up there.”

People spoken with confirmed that social activities took place and told us that they were free to join in or decline as they wished. One person said, “I don’t join in with everything but if they have entertainers in then I go along as they’re usually pretty good.”

People spoken with told us that they enjoyed the meals and confirmed there were plenty of choices available.

People spoken with praised the staff team. One person said, “They are very good, nothing is too much trouble for them, I can’t fault them.” Another person told us, “They’re lovely, very friendly and always around if you need them.”

Relatives we spoke with said they were happy with the care and services their family member received, and were involved in their care and reviews.

This inspection took place on the 30 and 31 March 2015 and was unannounced.

The Cedars and Larches is registered to provide accommodation, personal care and nursing care for up to 69 older people within two units. There were 48 people using the service at the time 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.

People who used the service told us they felt safe living at The Cedars and Larches and felt safe with the support workers who looked after them. Their relatives and friends agreed.

Staff had received training on how to keep people safe and they knew the actions to take if a safeguarding incident occurred.

Risks associated with people’s care had been assessed so as to provide the safest possible support. Where risks had been identified these had, where ever possible, been minimised to better protect their health and welfare.

Appropriate recruitment checks, including the collecting of references had been carried out when new staff had been employed. This was to check that they were suitable to work at the service. Staff had received training relevant to their role within the service and ongoing support was being provided.

People received their medicines as prescribed by their doctor. Their medicines were being managed in line with national guidance and the required records were being kept.

People told us there were not always enough staff around to meet people’s needs and staff members agreed. The management team acknowledged these concerns and told us they would increase the staffing numbers in the morning by one. This was observed in The Larches on the second day of our visit.

We have made a recommendation about staffing levels at the service.

People’s needs had been assessed before they moved to the service and plans of care had been developed from the assessments. The staff team were aware of the individual needs of those in their care and they supported them well.

People’s consent to the care and support they were to receive had been obtained when they first moved into the service and staff involved them in making decisions on a daily basis. For people unable to give consent, decisions had been made in their best interests by someone who knew them well.

People told us the meals served at The Cedars and Larches were good. People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. For people assessed to be at risk of not getting the food and fluids they needed to keep them well, accurate records had been kept showing their food and fluid intake.

People were supported to maintain good health, have access to healthcare services and receive ongoing healthcare support.

Throughout our visit we observed staff treating people with kindness and they supported them in a caring and considerate way. They involved people in making choices about their care and support and when choices were made, these were respected by staff.

Systems were in place to audit the service being provided and these were carried out on a regular basis.

People told us the service was well managed and the management team were available to talk with when required. Staff felt supported by the management team and told us they felt able to approach them at any time.