The inspection included reviewing training and supervision records and speaking with the provider, manager and three members of staff.
We found that staff did not hold all the relevant training and supervision in order to develop and improve their skills. This meant people may be at risk of care being delivered in an unsafe way and to an inappropriate standard.
The dementia unit had been redecorated and the communal areas had been re-carpeted. The refurbishments made it a better place for people residing at the home and demonstrated respect for people.
People's views and experiences were taken into account in the way the service was provided and delivered in relation to their day to day care. Meetings were held with people using the service and their families about the quality of the service provided and quality assurance questionnaires were distributed to those people.
People experienced care, treatment and support that met their needs and protected their rights. This included people's nutrition and hydration. Since the last inspection the provider had increased staffing levels on the dementia unit by one member of staff at lunch time, so that there was more staff available to assist people with their needs at that time.
People were cared for in a clean, hygienic environment, as we found the majority of areas in the home clean, tidy and hygienic.
Suitable arrangements were not in place in order to ensure that staff received appropriate training and supervision in relation to their responsibilities, to minimise the risk of them delivering care and treatment to people that may be unsafe or to an inappropriate standard.
The inspection team was led by a CQC inspector, joined by a practising professional and an 'expert by experience' (a person who has experience of using services and who can provide that perspective).
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.
We saw and heard staff speaking with people in an appropriate manner and staff had a good understanding of what people's body language was telling them. During our observations we saw that people interacted freely with staff. We observed that staff supported them in a way that promoted people's self esteem and individuality.
There were some aspects of the service provided that did not show respect for people's dignity and needs. For example, on entering the dementia unit there was an unpleasant smell. The dining room had dust on the skirting boards and stains on the walls. The flooring was ripped in places and was ill-fitted. The time on the clock was incorrect, which can be disorientating for people with memory impairment. There was a wipe board that had details of a person's hospital appointment displayed on it and also which person resided in each bedroom.
We saw that people had a choice of when and where they ate their meals. Some people chose to have their meals sat in the lounge, some in their bedroom and others went to the dining room.
Staff members that supported people with their meals were tactful and patient.
In our discussions with people they told us they were asked what they would like for their meal from the menu. They said there was always at least two choices and a choice of hot and cold drinks. People's comments about meals included, 'There's always plenty of food and if I fancy a little something during the day the staff always get it for me' and 'The food is a lot better than hospital food.'
We saw that drinks and bowls of fruit were available in the lounge.