The inspection took place on 5 December and was unannounced. The inspection continued 7 December 2016 and was announced.

Waypoints (Upton) is a purpose built nursing home registered to provide care for up to 67 people in the centre of the village of Upton. At the time of our inspection there were 46 people living there. People were living across three floors. Only half of the third floor was open. The people living in the home had complex care needs associated with their dementia.

Our last inspection on 2, 7 and 8 September 2015 found that systems and processes were not in place to ensure robust assessing and monitoring of quality, safety and risks. We saw that accurate records were not maintained. We also found that some people did not receive safe care and treatment. Risks were not assessed or mitigated effectively. People did

not receive their medicines safely and the risks of cross infection were not being managed effectively. During this inspection we found that improvements had been made.

The service had a registered manager in place. 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, relatives, a health professional and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe whilst having control and making choices about their lives. Each person had an online care record and associated files which included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, securely stored, correctly recorded and only administered by on duty nurses that were trained and qualified to give medicines.

Staff had a good knowledge of people’s support needs and received regular local mandatory training as well as training in response to people’s changing needs for example some people were displaying behaviour which challenged the service and staff had been trained in this area.

Staff told us they received regular supervisions which were carried out by the management team. Staff told us that they found these useful. We reviewed records which confirmed this.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in this. Capacity assessments were completed and best interest decisions recorded as and when appropriate.

People and relatives told us that the food was good. We reviewed the menu which showed that people were offered a variety of healthy meals. We saw that food was regularly discussed and recorded on food preference sheets. The chef told us that the majority of meals are home cooked.

People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, physiotherapist, mental health team and a chiropodist.

People told us that staff were caring. We observed positive interactions between staff, managers and people. This showed us that people felt comfortable with the staff supporting them.

Staff treated people in a dignified manner. Staff had a good understanding of people’s likes, dislikes and interests. This meant that people were supported by staff who knew them well.

People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these. We saw that these were regularly reviewed by the service with people, families and health professionals

The inspection visits took place on 1, 7 and 8 September 2015 and we spoke with professionals over the following week.

Waypoints (Upton) is a purpose built nursing home registered to provide care for up to 67 people in the centre of the village of Upton. The service opened in March 2015 and at the time of our inspection there were 38 people living there. People were living on two of the three floors. The people living in the home had complex care needs associated with their dementia.

The person registered with the Care Quality Commission as the registered manager was no longer in day to day management of the home, although they were available throughout our inspection. The current manager was applying to take on this role. 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 were moving in to the home at the time of our inspection; 11 people had moved in during the previous month.

Staff were not monitoring all areas of the home and this put people at risk of harm. Care plans to reduce risks associated with what people ate and drank and keeping their skin healthy were not always followed effectively and new and emerging risks were not assessed and planned for appropriately.

The provider had made appropriate applications for Deprivation of Liberty Safeguards as people were unable to make a decision as to where to live to receive the care and treatment they needed. This was in line with the Mental Capacity Act 2005. Some people needed further restrictions of their liberty to keep them and others safe. This meant that the staff used forms of restraint with some people. Staff were trained to use restraint but its use was not effectively monitored and did not reflect the provider’s policy.

Records kept by staff about people did not accurately reflect people’s experiences. This put people at risk of receiving care that was not appropriate because care support was planned based on inaccurate information.

Staff had an understanding of the provider’s ethos about dementia care and this was shown through their kind and gentle interactions with people. People had access to activities and the garden area of the home was well used throughout the time we were there.

The management team were responsive when we made them aware of our concerns. They also responded to staff concerns that were discussed in a whole team meeting. Concerns identified previously by the local authority had been responded to but this had not led to improved care for people.

There were breaches of regulation related to: how risks were managed; how people’s medicines were managed; how quality was monitored and how records were kept.

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