West Melton Lodge

West Melton Lodge is a residential care home providing personal care to up to 32 people. At the time of our inspection there were 28 people using the service. Some people using the service were living with dementia.

People’s experience of using this service and what we found

Since the last inspection there had been changes in the management team and the service had a new manager and regional manager. New systems and processes had been introduced to monitor the service, however new processes required embedding into practice and sustained to continue to drive improvements. Staff felt supported by the manager and told us they were approachable.

We found some minor discrepancies with the management of medicines. Following our inspection, the manager took action to ensure these concerns were appropriately addressed. We have made a recommendation that all medicines are documented correctly on the medication administration records.

Risks associated with people’s care were identified to keep people safe. However, risk assessments needed to contain more detail. People were safeguarded from the risk of abuse. Accidents and incidents were monitored by the manager and trends and patterns identified to mitigate future risk. The home was predominantly clean and there was a redecoration plan in place to address the décor.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 18 May 2022). Although we saw improvements had been made, the service remains rated requires improvement. Over the past 6 years this service has been inspected 10 times and has been rated inadequate on 3 occasions and requires improvement on the remaining. This service has been rated requires improvement for the last 4 consecutive inspections.

Why we inspected

We received concerns in relation to staffing, management of risk and governance. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Melton Lodge on our website at www.cqc.org.uk.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

West Melton Lodge is a residential care home providing personal care for up to 32 people. Some people using the service were living with dementia. At the time of our inspection there were 24 people living at the home.

People’s experience of using this service and what we found

Systems and processes in place to monitor the service had improved, however new processes required embedding into practice and sustained to continue to drive improvements.

Staff we spoke with had confidence in the registered manager and felt there had been several changes for the better since they commenced in post. Staff told us the registered manager was approachable and supportive.

We observed staff interacting with people and found they were kind and caring and involved people in their care. However, lunchtime was a little task orientated and the pictorial menu didn’t reflect the lunch choices available.

We carried out a tour of the home and found the provider had taken action to address the concerns we raised at our last inspection; however, some areas needed cleaning.

Risks associated with people's care had been identified and risk assessments were in place to minimise risks occurring.

The provider had a recruitment process in place. We found some minor discrepancies with pre-employment checks. Following our inspection, the registered manager took action to address this.

People received their medicines as prescribed. However, people who were prescribed medicine on an as and when required basis, did not always have protocols in place to inform staff how and when these should be administered.

People were safeguarded from the risk of abuse and staff knew how to recognise and report abuse.

Accidents and incidents were analysed to identify trends and patterns so future incidents could be minimised.

For more details, please see the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was rated inadequate (published 21 September 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 21 September 2021. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 3 August 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe and well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Melton Lodge on our website at www.cqc.org.uk

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

West Melton Lodge is a residential care home providing personal care for up to 32 people. Some people using the service were living with dementia. At the time of our inspection there were 17 people living at the home.

People’s experience of using this service and what we found

The service has a history of breaching regulations. Shortfalls related to governance had been noted at the five previous rated inspections of the service. The service was rated inadequate in 2016 and in 2017 and rated requires improvement in 2016, 2017, 2018, 2019, and 2020. This indicated a pattern of failure on behalf of the provider to ensure improvements were sustained. This inspection highlighted similar areas of concerns.

The provider had a system in place to monitor the quality of service provided. Some concerns raised during the auditing process were identified, although some issues were not resolved. We found concerns with the way health and safety issues of the building were managed.

We were not always assured that infection control was being managed in a safe way. For example, pedal bins throughout the service were not operating properly, a toilet floor was stained and worn, deep cleaning was not always being carried out, a mattress was heavily stained, and some areas of the building were worn and not able to be cleaned effectively. Action was taken following our inspection to reduce cross infection.

Risks associated with people’s care had been identified but were not always managed appropriately. For example, we found an item of moving and handling equipment which had not been serviced in line with LOLER [Lifting Operations and Lifting Equipment Regulations 1998] regulations.

On the day of our inspection we observed staff interacting with people and found there were enough staff to meet people’s needs. However, staff we spoke with told us they often struggled to meet people’s needs in a timely way. Staff felt this impacted on the choices available to people.

People received their medicines as prescribed however, we found areas that required improvements. For example, temperatures of the medication trolley stored in the communal lounge was not recorded. People who required medicines on an as and when required basis, had protocols in place, but these required more detail. We have made a recommendation about the storage and management of medicines.

Accidents and incidents were recorded. However, the analysis needed improvement to ensure incidents were appropriately analysed to ensure lessons were learnt.

Staff knew how to recognise and report abuse. The provider had a system in place which ensured staff were recruited safely. Pre-employment checks had been carried out prior to staff commencing employment at the home.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 21 January 2021) and there were breaches in regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service had deteriorated to inadequate.

Why we inspected

The inspection was prompted in part due to concerns received about infection control, staffing, training, and poor building maintenance. A decision was made for us to inspect and examine those risks.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We found the provider to be in breach of regulation 12 and regulation 17. These were continued breaches from the last our last inspection. The provider has taken action to mitigate the risks and if this has been effective.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection.

We have identified breaches in relation to safe care and treatment, infection prevention and control and good governance.

Please see the action we have told the provider to take at the end of this report.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Special Measures

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’ This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe, and there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

West Melton Lodge is a residential care home providing personal care for up to 32 people. Some people using the service were living with dementia. At the time of our inspection there were 19 people living at the home.

People’s experience of using this service and what we found

The provider did not ensure the leadership was consistent. Since our last inspection, there had been several changes in management. Governance systems in place to monitor the home, were not always effective and required embedding in to practice.

People's medicines were not always managed in a safe way. People receiving respite care did not have appropriate information in place to ensure medicines were administered as directed. We found two people's medicines were not given as prescribed. Following our inspection appropriate action was taken to address this.

We were not always assured that infection control was being managed in a safe way. For example, we saw staff arrived and left work in their uniforms, pedal bins throughout the service were not operating properly, items were stored on the floor of store rooms and some areas of the building were worn and not able to be cleaned effectively. We saw moving and handling slings were stored together in several areas of the home. Staff told us most of them were not in use. Action was taken following our inspection to address these concerns.

Risks associated with people's care had been identified but not always managed appropriately. Care plans gave minimal information about how risks were to be managed to keep people safe.

Staff told us there were enough staff available to meet people's needs, although on occasions they struggled. Staff told us that two staff were on duty throughout the night and this was not always sufficient to meet people’s needs. The provider had a system in place to identify the number of staff required. However, this tool did not take in to consideration the layout of the building.

Staff had received training in safeguarding people from the risk of abuse and knew how to recognise and report abuse.

The provider had a system in place which ensured staff were recruited safely. Pre-employment checks had been carried out prior to staff commencing employment at the home.

Accidents and incidents were recorded. However, the analysis needed improvement to ensure incidents were appropriately managed, to ensure lessons were learnt.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 February 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.

At our last inspection there was a breach of regulation regarding good governance. The provider completed an action plan to show what they would do and by when to improve. At this inspection we found the provider had not made sufficient changes to comply with this breach.

Why we inspected

The service was previously rated requires improvement and we needed to ensure the service was safe. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

Additionally, the inspection looked at the Infection Prevention and Control (IPC) practices the provider has in place. This is because, as part of CQC’s response to care homes with outbreaks of coronavirus, we are conducting reviews to ensure the IPC practice was safe, and the service was compliant with IPC measures.

We reviewed the information we held about the service. We did not inspect other key questions as no areas of concern were identified in them.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Melton Lodge on our website at www.cqc.org.uk.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

West Melton Lodge is a care home providing accommodation for up to 32 people. Most people were aged 65 and over. At the time of the inspection there were 13 people using the service.

People’s experience of using this service and what we found

The provider did not ensure the home was meeting the criteria for a good service. This showed that governance systems in place to monitor the home, were not effective.

Risks associated with people’s care had been identified, however information and guidance as to how to minimise risks, was not always available.

We completed a tour of the home with the registered manager and found some areas in need of repair. Some areas were in need of repair or refurbishment, which meant some areas could not be cleaned effectively.

The home had some dementia friendly signage, but this could be improved upon. People living in the bottom half of the building near to the conservatory had limited access to the main unit. However, following the first day of our inspection the provider acted to ensure people would have access to all communal areas of the home.

A dependency tool was in place to determine the amount of staff required. This did not take into consideration the layout of the building. Staff could be deployed more effectively to ensure all people living at the home had access to staff when needed.

People's needs were assessed, and care plans were devised to meet people's needs. However, some care plans were confusing, containing conflicting information.

Accidents were monitored to minimise reoccurring incidents. Appropriate actions had been taken.

People were safeguarded from the risk of abuse. Staff we spoke with knew how to recognise abuse and would report any concerns to the registered manager. People were supported to take their medicines as prescribed.

There was evidence that people were referred to healthcare professionals as and when required.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

We observed staff interacting with people and found they were kind and caring in their approach. People spoke highly of the staff stating they were like family to them. However, one person’s carpet had a strong malodour and required replacing. This compromised the person’s dignity. Appropriate action had been taken when we completed our second day of inspection.

Care plans did not always reflect people’s current needs and had historical information in them which presented confusion. Complaints were recorded, and appropriate actions taken. People had end of life care plans which ensured people's wishes were maintained.

The service had younger adults living there. The provider did not have this service user band on their CQC registration. The registered manager took action to address this.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement. (19 December 2018). At this inspection the service remained requires improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

You can read the report from our last inspections, by selecting the 'all reports' link for 'West Melton Lodge' on our website at www.cqc.org.uk.'

The service had a registered manager. 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.

West Melton Lodge is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service provides accommodation for up to 32 people in one adapted building. At the time of our visit there were 17 people using the service.

Medication procedures were in place for staff to follow and medicines were ordered, stored and administered safely. However, staff did not always document administration of as and when medication in line with the registered provider’s procedures, although they were administered as prescribed.

The service was predominantly clean; however, some areas were not well maintained so were not able to be effectively cleaned. The environment was also not dementia friendly. We also identified that due to some people’s mobility limitations they could not access the communal areas of the building which were accessed using a stair lift. The alternative was to access the different levels through an outdoor walkway which was not practical in poor weather.

The provider had improved the governance framework and quality monitoring completed had identified areas for improvement. However, the monitoring had not identified all of the issues that required improvement that we had picked up as part of the inspection.

The provider had safeguarding procedures and staff were aware of the procedures to follow to safeguard people from abuse.

There were dependency tools in each person care plan to determine how many care hours were required to meet their needs. However, the registered manager did not have an overview to show total hours. However, the registered provider has provided this since our inspection.

Risks were identified and managed so that people avoided injury or harm.

People who lack mental capacity to consent to arrangements for necessary care or treatment can only be deprived of their liberty when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). We found the requirements of the act were being met. People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible.

People received adequate nutrition and hydration to maintain their health and wellbeing.

Staff recruitment processes were robust. We found all the required pre-employment checks had been carried out. Staff received supervision and an annual appraisal of their performance. Staff told us they felt supported in their role.

We found staff approached people in a kindly manner and were respectful. People and their relatives told us staff were kind and very caring. Staff demonstrated a good awareness of how they respected people’s preferences and ensured their privacy and dignity was maintained. We saw staff took account of people’s individual needs and preferences while supporting them.

People's needs had been assessed and the care files we reviewed reflected people's care and support needs, choices and preferences. These had been reviewed and updated since our last inspection.

People were involved in social stimulation and activities in the home. Relatives and people who used the service told us the activities were good.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised. We found the registered manager had recorded these and investigated and recorded outcomes. People told us they were listened to.

The service did not have a registered manager. 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. However, the registered provider had appointed a new manager who commenced on 1 August 2017 and they had submitted an application to CQC to register.

At this inspection we found improvements. The new regional manager and the provider had followed the action plan submitted following our last inspection. Although at this inspection we identified three continued breaches, these had not adversely impacted on people who use the service and were mainly due to new systems that are still being embedding into practice. The service has been removed from special measures although further improvements must be made and sustained over time to ensure they meet the fundamental standards of safety and quality.

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors accessed by a passenger lift, although some rooms are only accessed by using stairs. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has gardens and there is a car park to the front of the property.

The provider had safeguarding procedures and staff were aware of the procedures. Staff had received training and people were protected from abuse.

At the time of our inspection we found there were sufficient staff on duty to meet people’s needs. However, staff told us this was because the occupancy was low, so they could manage.

Risks to people had been identified, but we found these were not always followed or reviewed to reflect current needs. Systems were in place for the safe management of medicines. However, we identified a number of errors that meant systems had not always been followed to ensure people received medications as prescribed.

The service was predominantly clean. However, some areas were not clean and the environment was not well maintained, therefore it could not be effectively cleaned.

We found that the recruitment of staff followed procedures. However, although three references had been sought for one member of staff they were not from a previous employer. Staff supervision took place and staff told us they felt supported by the new manager. Staff received training that ensured they had the competencies and skills to meet the needs of people who used the service.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some records were well completed and clearly documented the decision being made. However, we found some people’s best interests were not always documented. If they were documented they did not always involve all relevant people and did not clearly detail the outcome. Decisions being made were sometimes very general and not specific.

A well balanced diet that met people’s nutritional needs was provided.

We found staff approached people in a kindly manner. They were kind, considerate and caring. We saw most staff respected people and maintained their dignity. Although we observed some staff did not always respect people.

We observed staff did not always follow care plans, and that care plans did not always reflect people’s current needs which could put people at risk.

People and the relatives we spoke with were aware of how to raise any concerns or complaints and felt listened to.

We received many positive responses from people and relatives in relation to the management of the home. There were a range of formal meetings for people who used the service and their relatives to determine their thoughts and ideas.

The provider had systems in place to monitor the quality of the service. The manager completed several audits such as medication, infection control, staffing, building and premises, and health and safety. We found that some audits had not identified the concerns we highlighted as part of our inspection.

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

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property.

There was not a registered manager for the service in post at the time of the 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had left the same week as our inspection in November 2016; they were moved to another location owned by the provider. A manager who was previously registered at this location but left in 2016 was reappointed and commenced in November 2016. They had submitted an application to register with CQC.

The provider had systems in place to protect people from abuse and staff were aware of the procedures to follow. However, we identified these had not always been followed. People had not been protected and we made a safeguarding referrals to the local authority following our inspection.

People were not always protected against the risks associated with the unsafe use and management of medicines. Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines but these were not always followed.

People were assessed and risks to their safety and welfare had been identified. However, we found care was not always delivered in a way to manage these risks to ensure people’s safety.

We found there was adequate staff on duty to be able to meet people’s needs at the time of our inspection. However, from speaking with staff and people who used the service it was not clear if adequate staff were on duty in the evenings. We also identified from observations ineffective deployment and direction of staff meant people were not always appropriately supported.

We saw that appropriate pre-employment checks had been carried out to ensure staff were of good character and suitable to work with vulnerable adults.

We found the service was not always meeting the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). The staff we spoke with told us they had been requesting additional training as they were struggling to understand how this impacted on people they supported. People who used the service had been assessed to determine if a DoLS application was required. However, we found best interest decisions were not always made and where people had conditions as part of their DoLS authorisations had not always been met.

A well balanced diet that met people’s nutritional needs was provided. However, we found people were not always supported appropriately to be able to eat and drink. We found best practice guidance was not always followed for people living with dementia in respect of aids for eating and adaptations to the environment.

Staff told us they had undertaken training to give them the skills and knowledge to carry out their roles. However, we found training was not up to date and staff did not always follow best practice.

The people we spoke to told us that the staff were caring, kind and considerate. However, this was not always reflected in what we observed. We found staff could be task orientated and care was not person centred.

We found people’s care and support plans did not always reflect their needs. People were not involved in developing their plans and they did not always take into consideration their individual choices, preferences and interests.

People and their relatives we spoke with were aware of how to raise any concerns or complaints. Some complaints had been raised and it was not evident from records if appropriate action had been taken.

There were some processes in place to monitor the quality and safety of the service. However, we saw these were not effective and had not always been followed and had failed to identify the issues we found at the inspection.

We saw the process in place to ensure incidents were reported appropriately to the Care Quality Commission that are required by law had not been followed and incidents had not been notified.

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.

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

West Melton Lodge is in West Melton village, which is between Rotherham and Barnsley. The home is registered to provide accommodation for 32 older people. Accommodation is on two floors and a passenger lift is provided. There are several lounges and dining areas throughout the home. The bedrooms vary in size and some have en-suite lavatories. The home has landscaped gardens and there is a car park to the front of the property.

The home had a registered manager. They had been in post since November 2015 and registered in June 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law, as does the provider.

During this inspection we looked to see if improvements had been made since our last inspection in February 2016. We found improvements had been made across all aspects of the service and it was evident further improvements were in the process or were planned to be implemented. However, these improvements had been implemented by the registered manager and following our inspection they were moved to another service owned by the same provider. The systems in place to maintain the improvements had not been embedded into practice as they were new. We will carry out a further inspection of the service to ensure that improvements continue to be made and these have been embedded into practice and sustained over time.

We found that people had care and support plans in place and care records reflected the care they required. The plans had been reviewed and updated when people’s needs had changed. People’s risk assessments had also been reviewed to ensure their safety.

People were protected against the risk of abuse. Staff we spoke with were aware of procedures to follow and understood whistleblowing procedures.

People were supported with their dietary requirements. We found a varied, nutritious diet was provided. People we spoke with told us the food was always good.

We found the registered manager had a good understanding of the legal requirements as required under the Mental Capacity Act (2005) Code of Practice. The Mental Capacity Act 2005 sets out how to act to support people who do not have the capacity to make a specific decision.

Appropriate arrangements were in place for the recording, safe keeping and safe administration of medicines. However, we identified some improvements could be made.

There were robust recruitment procedures in place. Staff had received some formal supervision but this was not in line with the provider’s policy. The registered manager told us they had completed some annual appraisals and were organising others and they would be completed by the end of the year. Staff told us they felt well supported by the registered manager. Staff received training to be able to fulfil their roles and responsibilities. However not all training had been completed by staff.

The registered manager had implemented new systems to monitor the quality of the service provided. We saw these were completed and were effective. Improvements to the service continue to be identified and planned; these will need to be closely monitored by the registered manager so that these become fully embedded into practice and ensure they are sustained. However, these improvements were driven by the registered manager and she has been moved following our inspection to another service. The provider will need to ensure that a manager who is registered with the Commission continues to develop the systems to monitor the quality and safety of the service to identify, implement improvements and ensure these are embedded into practice.

This inspection took place on 2 and 3 February 2016 and was unannounced on the first day. At the time of the inspection 25 people were living in the home. The service was last inspected in September 2014 and no breaches of legal requirements were identified.

There was no registered manager at the time of the 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. The provider had appointed a new manager, who had started work a few days before Christmas. The manager told us they were preparing to apply to become registered.

We received mixed feedback from people living in the home and their visiting relatives, although most of the feedback was very complimentary regarding how nice the staff were, and about the care that people received. We found several areas for concern, as some risks to people’s health, safety and welfare were not appropriately managed. This included poor cleanliness and infection prevention and control in the home. The environment was not in a good state of repair or well decorated in some areas, and that there were physical hazards, such as trip hazards and security risks. Therefore, people were not always cared for in a hygienic and safe environment.

We saw that people’s health care needs were not always accurately assessed and risks, such as risks associated with use of the stairs and the use of bedrails were not always recognised. In some cases, support and advice had not been sought from healthcare professionals. In one case the person’s care plan was not being followed. This meant that people’s care was not well planned or delivered consistently. In some cases, this put people at risk and meant they were not having their individual care needs met. Additionally, the records staff kept about the care they delivered to people were not checked, leaving people at risk of not having their current, individual needs met.

There were few activities. The level of staffing support available did not adequately provide for people’s social and intellectual needs, and allow people sufficient freedom to go out into their local community.

Staff told us they received training, which helped them to carry out their role. However, not all staff had a good understanding of the Mental Capacity Act 2005. There were a number of people who lived in the home who were living with dementia, but not all staff had a good understanding of working positively with people living with dementia. Staff confirmed that they received supervision sessions with their manager.

The Mental Capacity Act (2005) (MCA) has been introduced as extra safeguards, in law, to protect people’s rights and make sure that the care or treatment they receive is in their best interests. The service was not meeting the requirements of the MCA (2005) for people who may lack capacity to make decisions. For example, people’s mental capacity was not assessed when particular decisions had been made. Additionally, some decisions made did not support people’s rights.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the necessary DoLS applications had been made.

There were 14 people living with dementia who lived in the home, and although some work had been done to make sure the environment was dementia friendly, it was not made wholly suitable for their needs.

People were not always offered choices or encouraged to be as independent as possible. For example, people told us they had very little input into the planning of activities, and there was limited choice in relation to meals and mealtimes.

Although people we spoke with told us the food was nice, suitable arrangements were not always in place to support people to maintain a healthy intake of food and drink. We saw that the management of nutrition was not always effective in making sure that people’s nutritional needs were identified, and that they were provided with individual diets that met their needs.

We saw that overall, medicines were ordered and disposed of safely, and administered to people by staff trained to do so. However, the storage temperature was not monitored for all of the medicines kept in the home. There was no guidance for staff about how people might express pain, when their communication had been affected by living with dementia, or under what circumstances staff should administer pain relief to them.

For the most part, positive caring relationships were developed with people who used the service. Staff spoke to people respectfully, and in a gentle and caring way. However, we did see instances when people’s privacy and dignity were not protected.

The provider did not have effective systems in place to identify the risks to people’s health, welfare and safety and in some instances, had failed to provide appropriate care to maintain people’s safety.

Audits were completed to monitor the quality and safety of the service provided to people. However, some of these audits had not been effective, and no action plans were in place to make sure any issues identified were followed up and improvements made.

People told us their views and opinions were taken in to consideration and people felt involved in suggestions and ideas about the home. However, we found that where people had asked for things to be improved, there was no indication that action had been taken to address them.

We found five breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking action against the provider, and will report on this at a later date.

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.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, speaking with the staff supporting them and looking at records.

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

Is the service safe?

People were protected against the risks associated with the unsafe use and management of medicines.

We observed people were treated with respect and staff maintained people's dignity.

Is the service effective?

The provider had an effective system to regularly assess and monitor the quality of service that people received. People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted upon.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people.

People we spoke with told us they were well looked after, One person told us, 'It is lovely here we are well looked after.' Another person said, 'I like it here it is a nice home.'

Is the service responsive?

The manager had identified concerns during routine audits and had implemented systems to ensure improvements.

Is the service well-led?

The registered manager was registered with CQC earlier in 2014. Since their appointment they have implemented improvements and followed through on the actions to ensure compliance actions were met.

The staff we spoke with said they worked well as a team and things had improved in the last few months. They told us the manager was approachable, listened and took action if required.

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

Is the service safe?

People were treated with respect and dignity by the staff.

We found inadequate quality monitoring systems were in place. This did not ensure the risks to people were identified and reduced, to be able to continually improve.

We found that medicines were not always recorded or administered safely and appropriately. Care workers did not always support people using the service to take and use their medicines appropriately.

Is the service effective?

People's health and care needs were reviewed, and they were involved in the reviews.

Audits and reviews had taken place, however when shortfalls were identified no action was taken. We found the same issues had been identified each month since September 2013.

Is the service caring?

We observed care workers interacted positively with people who used the service. Staff showed patience and gave encouragement when supporting people. One person we spoke with told us, 'I love it here I came on respite but wanted to stay, the staff are great.'

We observed the lunch time meal the experience was inclusive, calm, supportive and enjoyed by people who used the service. People were given choices and their preferences were respected. Staff gave appropriate sensitive support when required. People told us the food was very good and that the meals were a good time to talk to people and have a laugh and a joke.

Is the service responsive?

The manager was new in post and had identified a number of areas that required improving; however these at the time of our inspection had not been addressed.

Is the service well-led?

A new manager was appointed in October 2013 and has just completed the registration process with us.

People also told us that staff treated them with respect, listened to them, gave them choices, made them feel safe and supported them. One person told us. 'If I have any concerns I talk to staff and things are always sorted out.

Evidence showed people were protected from the risk of infection because appropriate guidance had been followed.

There were effective recruitment and selection processes in place and staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.

People's personal records including medical records were not always accurate or fit for purpose. The acting manager had identified this and told us they were going to implement a new format to ensure records were accurate.

Another person told us, 'Every member of staff is fantastic, look after people very well and work very hard.' However two people we spoke with told us they would like more activities as they at times were bored just watching television.

People told us that staff treated them with respect, listened to them, gave them choices and supported them.

People were not always cared for in a clean, hygienic environment. People's bedrooms and communal areas were found to be clean with no offensive odours, although some areas of the service were not well maintained or kept clean. These included the laundry and sluice facilities. The systems in place to reduce the risk and spread of infection were not always effective. The manager and provider had identified this and were putting measures in place to address the shortfalls.

Staff received appropriate professional development. A training programme was in place to provide staff with the training and support they needed. However some training required updating this included first aid and adult safeguarding. The manager had organised dates for staff to attend in January and February 2013.

There was an effective system to regularly assess and monitor the quality of service that people received. There was a complaints policy that took account of complaints and comments to improve the service.