This inspection took place on the 11 April 2017 and was unannounced. This inspection was carried out by two inspectors.

The Pines is registered to provide care, support and accommodation for up to eleven people who are living with dementia and have a learning disability. At the time of our visit nine people were living at the service.

A registered manager was 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.

At our inspection in April 2016 we made a recommendation that the registered provider follows the guidance and recommendations of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards when making specific decisions in people’s best interest. During this inspection we found the provider had addressed this. We found that decisions were made in people’s best interest and there was evidence that the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were being followed in daily practice. Records of the procedures to be followed when people did not have the capacity to make specific decisions were clear.

At our last inspection we made a recommendation that the registered manager must ensure that all staff talk using the English language when with people as they had become upset not knowing what staff were saying. During this inspection we found that the registered manager had taken action to improve this. Staff were being provided with English lessons paid for by the provider. During this inspection we did not hear any staff talking in a different language.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding adults and staff were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse. Information about keeping people safe was displayed in the home. The provider had carried out recruitment checks to help ensure that only suitable staff worked with people at the home. People were cared for by a sufficient number of staff to meet their care needs safely.

Medicines were managed in a safe way and recording of medicines was completed to show people had received the medicines they required. Risks to people had been identified and documentation had been written to help people maintain their independence whilst any known hazards were minimised to prevent harm.

Staff had received training and regular supervision meetings that helped them to perform their duties. New staff received a full induction to the service which included the mandatory training as required. Regular resident and staff meetings took place with the registered manager where people could put forward any suggestions about the home.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when required such as the doctor, dentist and psychiatric support.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a variety of meals and people were able to choose a meal that was different to the menu. People and their relatives were complimentary about the food provided.

People were treated with dignity and respect. Staff were observed supporting people with their personal care needs in the privacy of their bedrooms. People and relatives we spoke with were positive about the care provided and that their consent was sought by staff. People were positive about the caring culture of the home and all the people we spoke to said that they liked living at the home. Staff interacted with people in a caring manner spending time with them and supporting them to take part in their chosen activities.

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This inspection took place on the 7 April 2016 and was unannounced.

The Pines is registered to provide care, support and accommodation for up to eleven people who are living with dementia and have a learning disability. At the time of our visit nine people were living at the service.

A registered manager was 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.

We found that decisions were made in people’s best interest, however, we found evidence that the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards were not being fully adhered to in daily practice. Records were not clear about whether one identified person had the mental capacity to make a particular decision.

We made a recommendation that the registered provider follows the guidance and recommendations of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards when making specific decisions for people.

People were not always treated with dignity and respect. People and staff told us that some staff used a different language when they spoke with each other in front of people. This caused upset to some people at the service.

We made a recommendation that the registered manager monitors the communication to ensure staff can be understood by those they are caring for at all times.

People told us they felt safe living at the service. Staff had received training in relation to safeguarding and were able to describe the types of abuse and processes to be followed when reporting suspected or actual abuse.

Staff had received training and regular supervisions that helped them to perform their duties. New staff received a full induction to the service which included the mandatory training as required.

People and relatives we spoke with were positive about the care provided and their consent was sought. People were positive about the caring culture of the home and all the people we spoke to said that they liked the home.

People’s care and health needs were assessed and they were able to access all healthcare professionals as and when required.

People’s nutritional needs had been assessed and people were supported by staff to eat and drink as and when required. The menus provided a variety of meals and people were able to choose a meal that was different to the menu. People and their relatives were complimentary about the food provided.

Documentation that enabled staff to support people and to record the care and treatment they had received was up to date and regularly reviewed. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

Staff showed kindness and compassion and people’s privacy was upheld. People were able to spend time on their own in their bedrooms and their personal care needs were attended to in private.

There were enough staff to ensure that people could undertake their activities and to meet the assessed needs of people. Staff encouraged people to be independent and to do things for themselves, such as cooking and cleaning their bedrooms.

People and relatives told us they thought the home was well run and they were able to have open discussions with staff. People told us they felt able to raise concerns and make complaints if they needed to.

Quality assurance processes were in place to help drive improvement at the home.

People who lived at The Pines told us that they like to be referred to as Residents so we will use this phrase throughout this report.

Residents who were able to communicate told us that they were happy with the care and support they had received and that their needs were being met. They said that the staff treated them with respect, listened to them and supported them to raise any concerns they had about their care.

Residents told us that the service responded to their needs quickly. One said "I feel safe here, the staff are like my Mum and Dad." Another said "Staff listen to what we want. If I want to have a lay in I can stay in bed for as long as I like.”

There were ten people using the service on the day of our inspection. We were not able to hear the views of all the people directly due to their complex communication needs. We observed how staff interacted with people who used the service. We spoke with four people who used the service and three members of staff. The manager was on annual leave at the time of our inspection; however, we had a telephone discussion with her when she returned.

People who used the service were able to tell us that they liked living at the home. They told us they made choices about what they wanted to do. One person told us, “I am going shopping on my own this afternoon.”

People we spoke with told us that the food was nice and they could choose what they wanted to eat. One person told us, “My favourite pudding is bananas and custard and we have this.”

People told us they liked their bedrooms and they were able to use them whenever they wished to. One person conveyed to us that they liked being able to have their own posters on the walls.

We were told by people who used the service that there were enough staff on duty to help them. They stated that staff were nice to them.