Waterside Care Centre is registered to provide accommodation and nursing care for people for 47 people. At the time of our inspection 43 people were living there. The inspection took place on 10 April 2017 and was unannounced.

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 provider, 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 previously inspected Waterside Care Centre in August 2015. At the time of that inspection we rated the location as good overall. We found the safe question section to be requires improvement due to shortfalls in people receiving their medicines as prescribed in a consistent way to meet their health needs. The registered manager and her team had worked hard to address the areas for improvement identified at our last inspection.

At this inspection there were some shortfalls in how risks to people’s welfare had been recorded and followed through in practice. Staff practices and recording of risks to people’s welfare did not consistently match the actions required to provide assurances the identified risks to people were always managed in a safe way. Although we found no evidence of people being harmed by these shortfalls the registered manager acknowledged improvements were required.

People's medicines were managed safely but there were some gaps in medicine records where staff had omitted to sign when people had received their medicines. Staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Staff knew how to recognise and report any concerns to keep people safe from harm.

The registered manager assessed staffing levels dependent on people's level of needs. People were supported by staff who had the necessary skills and knowledge to understand and meet people's needs. Staff felt supported and had access to training relevant to their roles. Staff put into practice the knowledge they had gained which included seeking people's consent before supporting them and respected their decisions. Staff provided information to people in a way they understood to support them to make their own decisions.

Staff supported people in a kind and caring way. Staff knew and respected people as individuals and kept people at the heart of all the care they received. People were provided with food and drink which met their individual needs and preferences. Staff enjoyed their work and created opportunities for people to have fun and interesting things to do which met and stimulated their different senses.

People were supported to remain as independent as possible due to staff knowing people’s individual likes and dislikes. Staff were mindful to support people in a way which maintained their dignity and upheld their right to privacy.

People received individualised care which reflected their needs and wishes. People benefitted from flexible care and support which was responsive to changes in their needs and requirements. Relatives were given opportunities to comment on the quality of the service and felt comfortable to raise any concerns they had.

There was a positive working culture where staff and the registered manager worked together to provide good quality care. Relatives had mixed views about the management of the home but believed the care their family members received was safe and of a good quality. Quality checks were developed and implemented on an on-going basis to continually drive improvements in the service people were provided.

Our last inspection found that the provider was not meeting some essential standards. This inspection found that this was no longer the case and the provider was compliant in the outcomes we inspected.

During this inspection we spoke with the registered manager, members of staff, people that lived at the home and some of their relatives.

People were very complimentary about the care that was provided. They told us they were involved in planning their care. A relative said: “We are very happy about X’s placement here”. “I am really satisfied with the care my wife receives”.

People’s dignity had been respected. Relatives had been involved in supporting people with planning their care and their choices had been respected. Care was planned and records had been maintained. Reviews of care had been conducted regularly and changes made when necessary.

People were safeguarded from the risk of harm because staff had a clear understanding of their roles and responsibilities in this area. People had access to medical professionals.

Staff had been supported to do their work and told us that they had received appropriate training. Staff received regular training that enabled them to deliver care to an appropriate standard.

There were systems of audits in place to monitor the quality of the service provided. People were asked for their views about the home and these were listened to.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by a second inspector and an Expert by Experience that is a person who has experience of using services and who can provide that perspective.

Forty people were living in the home when we visited. Many of the people were not able to talk directly with us because of their dementia so we used different methods to see whether they received the care and support they needed.

We talked with three people who lived at the home and nine staff. We looked at the care records for three people who lived in the home to see how their needs should be met. We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

During our observations we saw staff treated people with respect and helped them to be as independent as possible. Throughout the day we observed staff supporting people with words of encouragement where needed whilst completing tasks. It was evident that staff had a good rapport with people and it became evident that they knew people’s likes and dislikes. We also saw that staff offered people choices during the day these included, how they wanted to spend their time and what they wanted to eat.

We observed lunch being served to people who lived in the home during our inspection visit. Staff were seen to offer people choices of where they would like to eat their meal and assistance was provided at people’s own pace. We saw that people were happy with the meals provided as we heard some people saying, their meals were ‘’good’’ and one person said ‘’lovely my favourite pudding.’’

Waterside Care Centre provides accommodation and nursing care for up to a maximum of 47 people. At the time of our inspection 46 people were living at the home.

There was a registered manager in place who was on duty throughout 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.

Where people were identified as needing their weight regularly monitored this was not always done and in need of improvement in order that identified needs were met.

We found that people were not always fully protected against the risks associated with the management of medicines and areas requiring improvement were identified and acknowledged during our inspection. We found occasions when medicines were not always given as prescribed and records were not always completed.

Relatives told us they had no concerns about the way their family member was treated and they believed they were safe living at the home. Staff were aware of their responsibility to take action if they were concerned about the treatment people received. Relatives told us staff were kind and caring towards people. We saw people were treated with privacy and dignity and staff were able to tell us how they upheld these areas of their practice.

Due to difficulties recruiting staff the registered manager had engaged regular agency staff as a means of providing consistency in the care provided. Efforts to recruit permanent nurses and care staff were ongoing.

People who lived at the home were supported by staff who were knowledgeable and received regular training and support from the registered manager and nurses. Care plans were in place and regularly update and reviewed by the nurses. Relatives were involved in reviewing care plans and in providing staff with information about people’s previous experiences and interest.

The registered manager had followed the principals of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards when assessing people’s ability to make specific decisions. Applications had been submitted to the supervisory body so the decision to restrict people’s liberty was made by people authorised to do so.

People had access to food and drink they enjoyed. Meal times were relaxed and people received the support and guidance needed to maintain their nutritional needs. People had access to healthcare professionals in a timely manner.

Relatives were made welcome and could visit their family member at any time. Relatives were aware of how to raise concerns or complaints and felt they would be listened to and action taken to improve the service provided. The registered manager encouraged relatives to be involved and share their comments about the quality of the service provided.

The registered manager had systems in place to monitor and improve the quality of service provided and as a way of making further improvements to the quality of care experienced by people.