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Inspection carried out on 9 February 2012

During an inspection looking at part of the service

During our visit to the service in July 2011, we identified a number of areas whereby the providers were in breach of regulations. We made six compliance actions to ensure the providers addressed these areas.

We returned to the home in December 2011 to check on the work undertaken to meet the compliance actions. Almost no action had been taken. Due to this and other shortfalls we identified within our visit, we issued two warning notices. These were in relation to cleanliness and infection control and monitoring and assessing the quality of the service provided.

This review was undertaken to ensure the providers had met the warning notices. Due to this focus and an awareness of people�s dementia, we did not talk to people who used the service in detail. We did not look at whether the provider had met the compliance actions we made in December 2011. Another review will be arranged to do this.

During our visit, we noted that significant improvements had been made in relation to the cleanliness of the home and infection control practices. Audits had also been devised to assess and monitor the quality of the service people received. Checks of the hot water temperatures, window restrictors and people�s bedrooms were in place. A consultant had also been employed to develop and monitor a new care planning system. Other audits such as medication and staff training had been identified but were not yet in operation.

The staff were very enthusiastic and motivated about the improvements made within the home. Many staff were completing extra shifts and some were doing developmental work in their own time. However, staff had not been consulted with about the additional responsibilities they had been given. They had not been given any specific training or allocated time to fulfil their new roles. This impacted upon the success and the timescale of the developments required.

Inspection carried out on 7 December 2011

During an inspection looking at part of the service

We completed this responsive review to check that the provider had addressed the compliance actions we made in July 2011. We saw that the provider had made no progress in meeting any of the compliance actions. All six compliance actions we set therefore remained unmet.

During this visit, we noted further significant shortfalls in the standard of cleanliness and the management of infection control practices. We saw cleaning materials were not being used safely and some equipment had not been properly maintained. People were at risk of scalding themselves through the excessive temperature of the hot water from three hand wash basins. We saw staff and the provider use poor manual handling techniques which put the person and themselves at risk of injury.

People did not have a choice of food offered to them. They had a set meal and dessert at lunchtime accompanied with squash or water. They had a cup of tea after their meal. People spent their time in the lounge. They had very little stimulation or social activity which met their needs. Care plans were in place yet these were not person centred and were difficult to follow. They did not identify how people liked to be supported or the management of any potential risk areas such as falling, nutrition and tissue viability.

The provider had not introduced a quality assurance process within the home. This meant there were no methods to monitor and quality assure the practice and systems in place. In addition, there were no informal audits of the service. People were therefore at risk of inappropriate or unsafe care and treatment. The lack of auditing also meant that poor delivery of care and training needs of staff were not being identified. People and their relatives did not have the opportunity to formally give their views about the service they received. They were not encouraged to make decisions and be involved in the provision of their care.

As a result of the provider not meeting the compliance actions we set in July 2011 and on identifying further non compliance, we started the enforcement process by issuing two warning notices. The warning notices require the provider to take action by 3 February 2012 to meet the regulatory requirements. If this is not achieved further enforcement action may be taken.

Inspection carried out on 22 July 2011

During a routine inspection

Due to their dementia, people were not able to tell us in detail about the service they received and what it was like to live in the home.

We saw that people were well groomed and generally settled. There were no signs of agitation or challenging behaviour. People were comfortable in the vicinity of staff and others. During our visit, people spent much of their time in the lounge. Staff organised skittles and some people engaged in this. Some people hit a balloon around with staff whilst also being asked questions such as �what shape is it?� and �what colour is it?� People were not always able to answer the questions appropriately. Some people played dominoes with a staff member. We saw that dominoes were the most successful activity, as people fully engaged and interacted well with the staff member. Whilst there were group activities people could join in with, there was no evidence of any individual work with people.

Staff told us that people were enabled to get up and go to bed when they wanted. They could eat in the dining room or the lounge. Staff supported some people to the dining room table at lunch time yet used inappropriate moving and handling techniques when doing so. People did not have a choice of meal or drink at lunch time. Some people were supported to wear a clothes protector yet were not given the choice of whether they wanted one. People ate their meal yet those who required support, were not given this on an individual basis.

There were areas of the environment, which did not promote good hygiene and people�s overall safety. There was a strong odour in the entrance hall and two bedrooms. Toilets, toilet brushes and less visible areas such as the underneath of the bath seat were dirty with brown debris and staining. Commodes were rusty and in need of replacement. Three windows on the first floor could be fully opened, as the window restrictors were broken. This created a potential risk of people falling from the window. There were cleaning substances not securely stored and the water from one hand wash basin was hot to the touch. A thermometer could not be located to confirm the water was of a safe temperature.

The landing and stairs carpet had recently been replaced. There were also some new armchairs in the lounge. Some pieces of furniture however, such as the chairs in the conservatory and coffee tables in the lounge, were in need of replacement. This was because the conservatory furniture was faded and frayed and parts of the coffee tables had lost their polished surfaces.

The staffing roster showed there were two staff on duty during the day. The providers were an integral part of the working roster and also undertook the majority of the cooking. During our visit, there were two staff on duty. They told us that as the providers were on holiday, they were responsible for supporting people, administering medicines, serving meals and drinks, cooking and cleaning. There was evidence that people�s physical needs were being met. However, it was evident that staffing levels impacted on staff�s ability to offer people one to one, person centred interaction. This included the ability to go outside for a walk or to be involved within any external community activity.

A complaint about the service has recently been made to Wiltshire Council. The concerns are in the process of being investigated.

Reports under our old system of regulation (including those from before CQC was created)