Archived: Tolverth House

An inspector carried out this unannounced comprehensive inspection on 19 March 2018. At this visit we met with the staff and people who used the service. We also spoke with a relative. Following the inspection we spoke with the deputy manager and the registered provider and checked what action had been taken in relation to concerns raised during our last inspections in September 2015, February 2016, September 2016, January 2017 and April 2017. At those inspections we found systems were not being operated effectively to assess and monitor the quality of the service provided. Due to the repeated breach of regulation 17 of the Health and Social Care Act, we issued a warning notice in September 2016. We reviewed this warning notice in January 2017 and found there continued to be no robust system of effective auditing in place meaning the provider was unable to identify or address any areas of concern. We then issued an urgent letter asking the provider to respond immediately to tell us how they would address the shortcomings of the service to ensure that people were safe. The provider responded and assured us, via their action plan, that all issues would be addressed by the 27 February 2017.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolverth House on our website at www.cqc.org.uk

We received two anonymous concerns about the service prior to this inspection. Some of the concerns were in relation to staffing levels and premises.

We spoke with the provider about the management structure and our increasing concerns that since September 2015 there had been consistent failings at the service. The service was rated inadequate at the January and April 2017 inspection and remains inadequate at this inspection due to continued failings.

For the last eleven months the provider hoped that the service was going to be sold. Staff were aware of the potential sale of the service as were relatives and people who lived at the service. The provider had therefore not invested in the service, for example with the people they supported, in its staff or its environment. Following this inspection we were informed the sale was not proceeding.

There had been limited financial investment in the service. For example there continued to be no operating central heating in the older part of the home. This had been raised at the last two inspections and no action had been taken to address this. We found generic risk assessments were completed about aspects of the premises, for example the use of standalone heaters. However staff were not following them and therefore were not taking the appropriate action to ensure that potential risks were minimised.

Since the last inspection the call bell system had been updated. However staff told us that they could not hear the call bell system upstairs if a person called for assistance. This meant that it could not be relied on when people called for assistance. We found people were exposed to both inadequate heating and ineffective call bell equipment which could place people at risk of not receiving care safely or promptly.

People were complimentary about the food. Staff told us there continued to be issues with appropriate budgets being available to purchase foods, “Especially in the last three weeks.” One staff member told us they had purchased food themselves and brought it to the service as there was insufficient food stock in the home at that time. This meant that people were at risk of not receiving sufficient nutrition.

At this inspection we found that the provider continued to be in breach of a number of regulations. There remained failings in the overall management of this service. We have reissued breaches of the regulations.

We have also reissued breaches in the area of inadequate care planning and records. For example there were no care plans in place to provide guidance for staff in how to support a person when they became agitated. Therefore care plans did not provide staff with up to date guidance in how to support a person consistently.

We found there continued to be no robust system of effective auditing in place and therefore the provider was unable to identify or address any areas of concern.

The provider had delegated responsibilities to the deputy manager and administrator. However they did not have meetings as a managers group to discuss their roles and their findings. Therefore there was no audit trail of how they planned to monitor and improve the service. We found there was inadequate leadership in place to support the staff team to work to improve the delivery of care.

The service is required to have a registered manager in post. The service had not had a registered manager in post since January 2014.

Due to continuing failures since 2015 we have no confidence in the provider’s ability to address the issues raised and establish an effective and robust system of auditing to enable them to identify and address all concerns.

There had been some improvements to the service. The stair lift was now working. This meant that people who needed to use this stair lift were able to move around the service independently. Recruitment systems were now robust. Concerns that were brought to the deputy manager’s attention were being addressed and referred as appropriate to commissioners.

The overall rating for this service remains ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Two inspectors carried out this unannounced comprehensive inspection on 25 April 2017. At this visit we met with the manager, staff and people who use the service. We also spoke with relatives. We revisited the service on the 3 May 2017 to meet with the registered provider and checked what action had been taken in relation to concerns raised during our last inspections in September 2015, February 2016, September 2016 and January 2017. At those inspections we found systems were not being operated effectively to assess and monitor the quality of the service provided. Due to the repeated breach of regulation 17 of the Health and Social Care Act, we issued a warning notice in September 2016. We reviewed this warning notice in January 2017 and found there continued to be no robust system of effective auditing in place meaning the provider and manager were unable to identify or address any areas of concern. We then issued an urgent letter asking the provider to respond immediately to tell us how they would address the shortcomings of the service to ensure that people were safe. The provider responded and assured us, via their action plan, that all issues would be addressed by the 27 February 2017.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolverth House on our website at www.cqc.org.uk

We received five anonymous concerns about the service prior to this inspection. Some of the concerns were in relation to the attitude and approach of the manager, staffing, premises and activities. They felt the manager had not taken on board their concerns or felt anxious that if they raised concerns there might be repercussions for their relative’s care or their employment. Staff raised serious concerns about the attitude and approach of the manager.

These examples demonstrated that some people and staff had little confidence in the management of the service. We discussed this with the provider who stated they had confidence in their manager. We spoke with the provider about the management structure and our increasing concerns that since September 2015 there had been consistent failings at the service. The service was rated inadequate at the January 2017 inspection and remains inadequate at this inspection due to continued failings.

We found at this inspection from the concerns raised, that there was no operating central heating in the older part of the home and staff told us this had been the case for “3 to 4 years”. Standalone electric heaters had been installed around the service. We found generic risk assessments were completed about aspects of the premises, for example use of standalone heaters, however staff were unaware of them and therefore were not taking the appropriate action to ensure that potential risks were minimised. We also found that the call bell system equipment was not monitored. On the second day of our inspection a fault with the call bell system occurred. No regular monitoring of the call bell system equipment was evident to ensure that it was regularly checked so that it could be relied on when people called for assistance. This meant that people were exposed to both inadequate management of the heating within the service and ineffective equipment which could place people at risk of not receiving care safely or promptly. We also found that a stair lift did not work effectively or reliably on both days of our inspection visit. This meant that people who needed to use this stair lift were unable to move around the service independently.

We found continued inconsistencies in records. For example some people had risk assessments in areas of care such as being supported to move around the service and others did not..

At this inspection we found that the provider continued to be in breach of a number of regulations. There remained failings in the overall management of this service which again resulted in breaches of regulations being identified. For example we have reissued breaches of regulations in the areas of management of risk to people that use the service and, the poor facilities, as cited above.

We have also reissued breaches in the area of inadequate care planning and records. We found that when peoples care needs had changed these were not amended on the persons care plan. For example a person’s night care plan said they were being cared for in a bed, however we found that the person was for their safety being cared for on a mattress on the floor. Therefore care plans did not provide staff with up to date guidance in how to support a person consistently.

In addition there was no documentary evidence to support why or how this decision had been reached or if the person, their family or other health or care professionals from outside the service was involved in this decision. When we returned to the service on the second day of our inspection, a week later, the person was now sleeping in a bed in another bedroom. Again no documentary evidence was available to show how this persons care needs had been assessed and what support the person needed. For example, previously the person had bed rails fitted to their bed prior to using the mattress on the floor, but no bed rails were now in place. No explanation was provided as to why bed rails were no longer needed. We concluded that there was no documentary evidence to show that an appropriate decision making process had been carried out involving all those with an interest in the person’s care and safety.

We found there continued to be no robust system of effective auditing in place and therefore the provider and manager were unable to identify or address any areas of concern. For example, care plans were not up to date, equipment in the service including the stair lift and call bells were not working effectively and the heating system did not work.

We also identified new breaches at this inspection for example in relation to complaints and medicines. It is of serious concern that areas that did have a breach in regulation in the past, such as medicines (September 2016) which were later compliant (January 2107) have now been issued with another breach of regulation. This raised concerns that the provider had not been able to maintain the consistent standards needed to ensure compliance with regulations over a period of time. These examples showed that the service’s quality assurance processes were not operated effectively and the provider and manager had failed to identify areas of significant concern.

The manager told us they had delegated responsibilities to the deputy manager, administrator and a specified care worker. However they did not have meetings as a managers group to discuss their roles and their findings. The provider and manager acknowledged that no written records of discussions had occurred so that there was no audit trail of how they planned to monitor and improve the service.

Staff told us they had no discussions with the manager about the latest inadequate rating of the service. A staff meeting was held with the provider but staff felt it was not discussed in depth. The minutes did not evidence that a discussion around the rating of the service or what action needed to be taken to improve standards at the service had occurred. Therefore staff were not aware of what actions they needed to take to ensure that the failings identified at previous inspections could be addressed. There was inadequate leadership in place to support the staff team to work to improve the delivery of care.

Due to continuing failures since 2015 we have no confidence in the provider’s ability to address the issues raised and establish an effective and robust system of auditing to enable them to identify and address all concerns.

The service is required to have a registered manager in post. At the time of our inspection the manager in charge had not been registered with the commission. The service had not had a registered manager in post since January 2014. The present manager was appointed in January 2014 and they had day to day responsibility for running the service. In June 2016 the provider informed us that they had appointed the same manager to also manage the registered provider’s other care service, which is in another county and a considerable distance from Tolverth House. An application to the commission was received by the manager to register for both services in October 2016. However in February 2017 the manager withdrew their application to manage both services. The manager has not submitted an application to manage Tolverth House and to date we have not received a valid registration application for registration of the manager at Tolverth house.

We noted that there had been some improvements to the service. For example, people told us they were supported by staff who showed genuine care. In addition we noted that supervision was occurring and training had increased.

The overall rating for this service remains ‘Inadequate’ and the service is therefore in ‘special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the p

We carried out this unannounced comprehensive inspection of Tolverth House on 9 January 2017. At this visit we checked what action the provider had taken in relation to concerns raised during our last inspection in September 2015, February 2016 and September 2016. At that time we found repeated breaches of legal requirements related to the service such as: a lack of training and supervision for staff, recruitment records were not robust, and ineffective auditing systems. We issued a warning notice as part of our enforcement process.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolverth House on our website at www.cqc.org.uk

There had been no registered manager in post since January 2014. 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. The manager had submitted a valid application which is being considered by the Commission.

The manager told us they had less time at Tolverth House to undertake their managerial duties as they were now managing both Tolverth House and the provider’s sister home which is approximately one hundred miles away. The consequence of this was that the manager had doubled their day to day managerial responsibilities and needed to divide their time equally between the two services. However, there remained failings in the overall management of this service which again resulted in breaches of regulations being identified.

We found there continued to be no robust system of effective auditing in place and therefore the provider and manager were unable to identify or address any areas of concern. For example, at the September 2015 inspection we found that care plans were not in place for all people at the service. This was found again for two people at this inspection. We also found that risks were not identified or assessed formally. Therefore there was no action agreed on how any risks could be minimised. This meant staff did not have information, direction or guidance on how to support a person’s care needs.

Likewise we found at the inspections in September 2015, February 2016 and September 2016 that recruitment processes were not followed consistently. The manager showed us they had introduced a new audit trail for recruitment of staff following the last inspection. However, we found that the new system was not being implemented consistently.

The registered provider had introduced new job specifications for the manager and deputy manager. Due to this change the manager had delegated some tasks to the deputy manager and a specified care worker. The provider and manager acknowledged that no written records of these discussions had occurred so that there was no audit trail of how they planned to monitor and improve the service.

We had identified that the provider had not been notifying us of significant events in the September 2016 inspection. The provider is required by law to submit notifications to CQC of significant events such as injury or any safeguarding concerns. We found the service had not submitted statutory notifications as required since the September 2016 inspection. This demonstrated the provider continued to not act in accordance with their legal responsibilities.

Following each inspection we requested that the provider submit an action plan on how they would address the shortfalls of their service. To date we have not received any action plan. From the issues highlighted in previous reports and in this report, it is of concern that the management team have not openly shared with us how they intend to address the failings of the service.

These examples evidence that the service’s quality assurance processes are not operated effectively and the provider and manager has failed to identify areas of significant concern.

We received mixed views from people about how safe they felt and about the care they received. One person and a relative told us that “The care during the day is 100%. It’s the night time that isn’t.” Another person told us they were content. We also saw a letter of thanks from a relative about the service their family member received.

We had received concerns about staff practices from an emergency health care agency, a person using the service and relative. We also noted in records that the language staff used to describe people was not always respectful. We concluded that safeguarding allegations had not been investigated thoroughly by the service and that the reporting procedure for safeguarding had not been followed. We have made a safeguarding alert to the local authority in this regard.

We found that there continued to be a lack of oversight from the management team in the running of the service. Staff were now being provided with training and some support, to give them the knowledge and skills to carry out their roles safely. We concluded that whilst some progress had been made in the provision of staff training and supervision there had not been sufficient time to analyse if the actions taken in this area had been effective.

The manager and staff had a general understanding of the legal requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards. We found that there were some restrictions in place such as pressure alarm mats and that further assessments and applications in respect of these restrictions needed to be completed.

We noted that there had been some improvements to the service. For example, the medicine system was now robust and the premises were clean and tidy. Staff meetings were occurring which allowed the staff the opportunity to share their views on the running of the service. The registered provider said they visited the service approximately fortnightly which the staff viewed as supportive. The manager told us they had received support from a ‘mentor’ who works within the care sector.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We carried out this unannounced comprehensive inspection of Tolverth House on 8 September 2016. At this visit we checked what action the provider had taken in relation to concerns raised during our last inspection in September 2015 and February 2016. At that time we found repeated breaches of legal requirements related to the service such as: a lack of training and supervision for staff, recruitment records were not robust, and ineffective auditing systems.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolverth House on our website at www.cqc.org.uk

There had been no registered manager in post since January 2014. 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.

The present manager stated they intended to apply to become registered for the service. At the last two inspections the provider told us the manager would submit their application but at the time of this inspection visit a valid application had not been submitted.

The manager told us they had less time at Tolverth House to undertake their managerial duties as they were now managing both Tolverth House and the provider’s sister home which is approximately one hundred miles away. The registered provider had recently promoted a senior carer to deputise at Tolverth House and support the manager. However there was no clear understanding of the delegated roles and responsibilities of the two managers. This meant the manager had less time to undertake their managerial role and address areas of work needed at this service.

We found that there continued to be a lack of oversight from the management team in the running of the service. At the last inspection we found staff had not received regular training or support to provide them with the knowledge and skills to carry out their roles safely. On this inspection we found that the registered provider had made sure that more training was being provided. We therefore found that the service had partially complied with the previous breach of regulation, in that training was now provided to staff.

At the previous inspection we identified that the manager was not providing staff with individual support, through individual supervision sessions. At this inspection the manager confirmed supervision sessions for staff had not occurred. This meant time to individually discuss with staff their work practice and development was not currently in place.

In addition at the last inspection we found a breach of Regulation in respect of recruitment processes. At this inspection we found this was still not being carried out appropriately. At this inspection we found that recruitment checks were not consistently followed for all newly appointed staff. The systems in place at the time of this inspection did not protect people from the risk of being supported by staff who may be unsuitable for the role.

We identified new concerns at this inspection. The systems in place for the storage, administration and recording of medicines were not robust. We noted that the Medicines Administration Records (MAR), were not completed as required. Therefore the service could not account for all medicines they held in the service. Recording on the MAR sheets was not wholly accurate. Audits of medicines had not been completed and therefore did not identify any potential issues. This meant that the storage, administration and recording of medicines could place people at risk.

We found the main lounge and people’s rooms to be clean and tidy. However we noted a cat urine odour as we entered the service and saw cat excrement in another area of the service. On looking further it appeared that the area had not been cleaned for some time. The cleanliness of the service was not being adequately monitored to ensure acceptable standards were maintained

The provider is required by law to submit notifications to CQC of significant events such as injury or any safeguarding concerns. We found the service had not submitted statutory notifications as required to inform us of incidents that had taken place.

These issues demonstrate that the service’s quality assurance processes were not operated effectively and that the provider and manager had failed to identify areas of significant concern.

We received positive comments from people who lived at Tolverth House. Comments included “Staff speak to me naturally, they joke and are very down to earth, they do not make me feel inferior, and they treat everyone with respect. They always knock on my door and wait for a reply” and “I get on with staff it’s like a big family.” People told us they were completely satisfied with the care provided and the manner in which it was given. We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. Staff responded to people’s request for assistance promptly. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner.

We received positive comments from a relative about the care their family member received. Comments included: “Staff here are wonderful.” They told us they were always made welcome and were able to visit at any time. People could choose where they met with their visitors, either in their room or in different communal areas.

People told us they felt safe living at Tolverth house. Comments included: “I feel safe here, no bullying. I am calmer and happier here”, and, “I feel very safe here, staff are very kind they never shout or swear.” A relative told us they felt their family member was cared for safely. We saw throughout our visit people approaching staff freely without hesitation and that positive relationships between people and staff had been developed. Staff were confident about the action they should take if they believed anyone was at risk from abuse.

Care plans were personalised to the individual and gave clear details about each person’s specific needs and how they liked to be supported. This information provided direction and guidance for staff to follow to meet people’s needs and wishes. For example, care plans described how staff should assist people with their personal care including what they were able to do for themselves.

Staff meetings were occurring which allowed the staff the opportunity to share their views on the running of the service. The registered provider visited the service approximately monthly which the staff viewed as supportive. The manager told us they had received support from a ‘mentor’ who works within the care sector.

The provider had commissioned a quality assurance review of the service in the area of health and safety. Following this review further environmental improvements to the service were planned. An on-going maintenance plan to ensure that all areas of the service were safe was in place.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

We carried out this unannounced focused inspection of Tolverth House on 23 February 2016. At this visit we checked what action the provider had taken in relation to concerns raised during our last inspection in September 2015. At that time we found breaches of legal requirements related to the service as: the current staffing levels were not able to meet people’s needs safely at all times: a lack of training and supervision for staff: not ensuring that care plans were in place or up to date and ineffective auditing systems.

This report only covers our findings in relation to the ‘Safe’, ‘Effective’ and ‘Responsive” and Well Led’ domains covered in this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Tolverth Houser on our website at www.cqc.org.uk

There had been no registered manager in post since January 2014. 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.

The manager stated they had attempted to submit an application to be considered as a registered manager in the past but it was not accepted. .At the last inspection the manager reassured us they would resubmit this application but it still had not been received.

At the last inspection we found staff had not received regular training or support to provide them with the knowledge and skills to carry out their roles safely. Supervision sessions with the manager had not occurred. This meant staff did not receive effective support and any on-going training needs or personal development requests may not have been acted upon. The manager told us, that supervision had commenced plus an annual appraisal. We saw some staff supervision records but could not be confident that supervision had been provided to all staff.

There was a planned programme of refresher training in place. The registered provider had organised for a trainer from one of the other company’s care homes to come to the service in March. Training in the areas of moving and handling training, infection control, safeguarding and medicines were planned. The manager told us this would mean all staff would be up to date in these areas. A visiting trainer from the local college told us that they were supporting some staff with their training needs and supporting one person to complete their care certificate.

At this inspection we found the recruitment process was not robust. We found that each candidate had completed a Disclosure and Baring check to show people were suitable and safe to work in a care environment. However we found candidates had not completed an application form and references were lacking. This meant the recruitment process was not safe.

At this inspection we found that the manager was still unaware of the outcomes of the quality audits that the registered provider had completed and therefore was not confident of its findings. As the manager was unaware of the results of the provider’s quality assurance assessments they were unable to address any areas of concern these assessments may have identified. This meant the service’s quality assurance processes were not operated effectively as these systems had failed to identify areas of significant concern, For example recruitment records as outlined in the safe section of this report.

At this focused inspection we found some improvements had been made. The registered provider and manager had reviewed staffing levels. From this review they identified the need for an increase in staffing hours in the morning time. In addition staff roles, such as the domestic’s role, had been reviewed. This meant care staff no longer made the beds and therefore gave them more time to undertake caring duties. Staff and the manager felt the increase in staffing and role allocation had a positive impact as carers had “More time to be with people. We don’t need to rush as much as we did,” and “When they (people) ask us for anything we can respond more quickly.” People also commented that staff had more time and were prompt to respond to their requests for assistance. The increase in staffing meant that the manager had more time to undertake management responsibilities in the service

Care plans were now in place for every person at the service. The manager had reviewed every person’s care plans. We found they were reflective of people’s current care needs, were well laid out and comprehensive. Staff commented that care plans directed, informed and guided them in how to provide care for people so that consistent care was provided. Staff commented “The managers’ worked hard updating all those care plans. They are now accurate. They are really good and so informative.”

The manager told us they had received support from a ‘mentor’ who works within the care sector who planned to visit four times a year. This had helped the manager as they reviewed the systems of the service and provided advice. The manager also has monthly visits from the registered provider.

Continued environmental improvements to the service were evident, for example new flooring had been laid since our previous visit. An on going maintenance plan to ensure that all areas of the service were safe was in place.

People told us they were completely satisfied with the care provided and the manner in which it was given. We saw staff providing care to people in a calm and sensitive manner and at the person’s pace. When staff talked with us about individuals in the service they spoke about them in a caring and compassionate manner.

We found three Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the end of the full version of the report.

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people using the service, their relatives and the staff told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

People told us they felt safe and secure. The people we spoke with were positive about the staff who worked with them. People told us staff were caring and supportive. For example one person said 'The staff are very, very nice and understanding'they are very good.'

The staff that we spoke with said they had confidence in colleagues' practice. Staff told us if they had any concerns about how people who used the service were cared for the registered provider would take their concerns seriously.

We saw that the home was well designed and maintained. Decorations and furnishings were homely, clean and comfortable. Equipment was well maintained and regularly serviced. Health and safety records were generally up to date. However some improvement was required to health and safety risk assessment procedures. Some fire prevention equipment needed to be more frequently checked by staff.

On the days of the inspection the home was very clean and there were no unpleasant odours. The people who used the service all said they were happy with the standard of cleanliness. People said the laundry service was satisfactory, although some people said at times some clothing would temporarily go missing and/or they would receive the wrong item back.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people's needs throughout the day. People said they received a consistent and safe level of support. For example we were told if people rang the call bell staff would come to assist them promptly.

Is the service effective?

People all had an individual care plan which set out their care needs. Care plans contained satisfactory information and were accessible to staff. People said staff met their needs and responded promptly when they needed assistance. For example one person said 'I cannot fault the staff, they are very caring.'

People had access to doctors, district nurses, chiropodists and opticians. However some people said they had not seen a dentist and would like to. Records regarding what medical professionals people should see, and had seen could be improved. However overall people were sure that their individual care needs and wishes were known and planned for.

Records showed most staff had received satisfactory levels of training, although training delivery could be improved for one person. Staff deemed managers and supervisory staff as helpful and supportive, but records did not demonstrate staff had received formal one to one supervision since December 2013.

Is the service caring?

The majority of people said they were supported by kind and attentive staff. The care practice we observed was kind and caring. All but one of the people we spoke with was positive about the care they had received. Comments included 'The home is very nice, I have no complaints,' and 'It is very good'the staff are nice.' One person said they thought care was good but they raised a concern about one member of staff. This matter was discussed with the registered provider.

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

The majority of people we spoke with all said the staff treated them with respect and dignity. The care practice we observed was professional, kind and supportive.

People who used the service, and staff told us there was a range of activities available. This included a monthly outing. If people did not want to get involved with organised activities this was respected.

People were positive about the care they received. The majority of people we spoke with said their care was unrushed and received in a way they wanted staff to provide it. From reviewing records we judged care plans as including suitable information to assist the staff who worked at the home.

People we spoke with said staff would listen to them, and respond appropriately if they had a concern or a complaint.

Is the service well-led?

The home had a system to assure the quality of the service they provided. People's personal care records, and other records kept in the home, were accurate and complete.

People who used the service, and the staff were positive about the registered provider and the manager. The manager had not applied to be registered with the Care Quality Commission although the registered provider assured us this would now occur.

Staff were very positive about the new management at the home. For example one member of staff described the manager as ' very good, she has made a real difference here, she is very easy to talk to and problems will be solved quickly'

We observed the staff interacting with people who used the service and saw they were polite and respectful at all times.

People told us at the previous inspection and during this visit that clothing returned from the laundry was not always labelled or returned to the rightful owner of the garment. This did not ensure the dignity of people was respected.

People who used the service made positive comments about the activities which were provided on three afternoons a week. However, it was not evident people were supported to partake in meaningful activities the rest of the time.

We were told that there were insufficient staff on duty at times and our observations during the inspection supported this in part.

People were not consistently protected from the risk of infection because appropriate guidance had not been followed.

People told us and we observed clothing returned from the laundry was not always labelled or returned to the rightful owner of the garment. This did not ensure the dignity of people was respected.

People who used the service made positive comments about the activities which were provided on three afternoons a week. However, it was not evident people were supported to partake in meaningful activities the rest of the time.

We had concerns how the health care needs of two people were met as one person, the staff and the care records provided different accounts of who was responsible for specific care needs.

People were not consistently protected from the risk of infection because appropriate guidance had not been followed.

Staff were supervised and trained, although at times were not in sufficient numbers or deployed appropriately to ensure the care needs of people who used the service were met.

The privacy and dignity of people living at the home was not always maintained and respected. Personal records of people living in the home were accessible to other people.

Staff were not effectively supervised. Records did not show that certain areas had been discussed such as working practices or training. A new form had been introduced but had not been implemented on the day of our inspection.

We saw the home appeared to be clean, however there was not an effective system to identify any infection control issues.

The provider had taken steps to ensure the home had gained the appropriate professionals to test and maintain equipment used in the home.

There was not an effective system in place to monitor the quality of service provided to people.

The complaints policy and procedure did not contain information on how to make a complaint and to whom. One person had been assisted to express a complaint but the homes' documented procedure had not been followed as described.