This inspection visit was unannounced and took place on 23 January 2017. The service was registered to provide accommodation for up to 27 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 26 people were using the service.

There was a registered manager in post, who was also the provider and owner. 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 our last inspection visit on 5 April 2016 we asked the provider to make improvements to assessing people when they were unable to make decisions for themselves. The provider sent us an action plan in June 2016 to explain the actions they would take to make improvements. At this inspection, we found improvements had been made.

People were supported to make choices and when required, assessments had been completed to ensure decisions were made in people’s best interest. The home had enough staff to support people’s needs. Any staff who had been employed had received a range of checks to ensure they were suitable to work in the home. The manager and provider had established a range of audits to support the improvements within the home. We saw feedback was sought from people, relatives and staff 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. They ensured they maintained people’s privacy and dignity at all times. People were able to choose the meals they wish to eat and alternatives were provided. We saw that medicines were managed safely and administered in line with people’s prescriptions. Referrals had been made to health care professionals and any guidance provided had been followed.

Staff obtained information to ensure the care reflected people’s needs and preferences. People were encouraged and supported with activities they wish to engage in. Any 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 about the service and the needs of people. Staff had received training and felt confident to share their knowledge to improve their role.

The previous rating was displayed in the reception of the home 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.

This inspection was unannounced and took place on 3 March 2016.The service was registered to provide accommodation for up to 28 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection, 27 people were using the service.

There was a registered manager in post, who was also the provider. 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 our last inspection in April 2014, we had no concerns identified about the service.

The provider and deputy manager were not clear on their understanding and responsibilities in complying with the requirements of the Mental Capacity Act 2005 (MCA). We observed some people lacked capacity in certain areas; appropriate assessments had not been completed to show how people were supported to make those decisions. We saw that authorisations to request a Deprivation of Liberty Safeguards (DoLS) had been completed as appropriate.

The provider determined the staffing levels on the number of people living in the home and the level of support they required. Staff had been trained to support people’s needs and on-going training was offered as directed from audits or staff request. Staff had identified they required additional training in MCA and DoLS. People felt safe within the service and staff understood their role in ensuring people were protected from abuse or poor practice.

Staff knew people well, many of the staff had been working at the service for a long time so people received consistent care and support. People were responded to in a kind and friendly manner and respected for their decisions. Risk assessments were in place to ensure people’s safety was maintained.

Medicines were managed safely and in accordance with good practice. People received food and drink that met their nutritional needs and had a choice of the foods they wished to eat. Staff had made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

Staff were caring in their approach and they created a warm homely environment which people told us they liked and enjoyed. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home.

The provider and deputy manager had systems in place to monitor the quality of the service. People and their relatives had provided feedback on the service to drive improvements and personalised support. The provider had a ‘hands on’ approach in quality assurance to ensure good practice was maintained. Staff felt supported and respected by the provider.

You can see what action we told the provider to take at the back of the full version of the report.

We spoke with two people and one relative. They told us they had no concerns with the care provided and were supported by staff who they liked. We saw that appropriate checks were undertaken before staff began work. This ensured that staff who were employed were safe to work with people living at the home.

We observed a staff member giving medicines to different people. We saw that the staff member waited patiently to ensure that medicines were properly swallowed. This showed that medicines were given to people in a safe way.

Records in the office were held securely. They were updated as required or on a monthly basis. A locked filing cabinet was provided to ensure all personal information remained confidential. Records held on the computer were accessed by a password and was restricted to a few staff. One person we spoke with confirmed that they were aware of records about them being held within the home and if they wanted to see them they could ask to see them.

People we spoke with praised the home. One person told us it’s “absolutely excellent”, another stated “it’s one of the better homes”. One person stated, “the word care home really fits, as they really do care”. Comments about the staff included “marvellous” and “nothing is too much trouble”. People were treated with dignity and respect.

People were happy with the care provided and there was evidence that staff were aware of the needs of people who used the service and were able to meet those needs.

We found that there were concerns with the recording of medication and the provider had not followed their own policy.

We looked at three staff files which all contained an up to date criminal record check. However not all pre employment checks were carried out in line with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We found that although staff were meetings people’s needs, records were not accurately maintained.

On the day we inspected there were 22 people who used the service. We spoke with five people who resided at the home who were able to communicate with us, five relatives and five members of staff including the manager.

One person we spoke with stated it “doesn’t feel like a home, it feels like home”. Another person stated it had a “nice family atmosphere”. One person told us that they would give the home “10 out 10”.

One relative told us that they felt “really lucky to have found this home” and another person stated that it was “very good, very pleasant and (staff were) very attentive”.

All the people we spoke with were happy with the care provided by staff. One person stated that they “do a marvellous job” and “go over and above the call of duty”. , another told us that “carers care”. A thank you care we saw read “your staff are completely wonderful”.

We found there was some concerns with care plans.

We spoke to eight people who use the service, five relatives and six members of staff.

People able to express their views spoke highly of the care and support they received, and felt that their needs were being met.

People said they get the help and support they need as there is usually enough staff on duty. People felt that staff treated them with dignity and respected their privacy. People also felt safe and able to raise concerns with staff if they were unhappy.

Most people considered that their social needs and interests were met; two people felt that more activities were needed.

Relatives praised the care and support their family member received, and felt involved in decisions about the care and treatment.