Cann House Care Home

Cann House Care Home (thereafter known as Cann House) is a residential care home providing personal and nursing care, in one adapted building. The service is registered to support a maximum of 62 people. There were 47 people living at the service at the time of the inspection.

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

Since our last inspection improvements had been made in how risks to people were assessed, monitored and managed. People told us they felt safe with the support they received from staff. People received their medicines as prescribed and were protected from avoidable harm and abuse. There were adequate numbers of staff to meet people’s needs. Recruitment processes ensured new staff were suitable for their role. Staff felt supported by the management team and had the skills to meet people’s needs. Staff followed safe infection prevention and control practices.

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.

The provider, registered manager and staff were clear about their roles and responsibilities. People’s views about the service were sought and listened to. Quality assurance checks were in place to monitor the quality of the service provided.

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 (2 October 2021).

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

Why we inspected

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 to good. 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 Cann House Care Home 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.

Cann House is a residential care home providing personal and nursing care, in one adapted building. The service is registered to support a maximum of 62 people. There were 56 people living at the service at the time of the inspection.

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

The ongoing risks associated with people’s individual care needs were not always managed safely, and the systems in place to monitor the quality of service were not always effective.

People's rights to make own decisions were respected. 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.

People and their relatives were very positive about the service and the care provided. People received their medicines regularly. Enough staff were available to meet people's needs and staff responded promptly to people requiring support.

The service continued to be effective. People's needs were assessed, and care was planned and delivered by staff who were well trained and knowledgeable about people's care and support needs.

People were encouraged to maintain good diet and access health services when required. People had access to a wide range of activities and were supported to avoid social isolation.

Incidents and accidents were investigated, and actions were taken to prevent recurrence. The premises were clean, and staff followed infection control and prevention procedures. People's dignity, confidentiality and privacy were respected, and their independence was promoted.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The model of care and setting in the service maximised people’s choice, control and independence. The care delivered is person-centred and promotes people’s dignity, privacy and human rights. The Ethos, values, attitudes and behaviours of leaders and care staff ensured people using the service lead confident, inclusive and empowered lives

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 Good (published 12 August 2020).

Why we inspected

The inspection was prompted in part due to concerns received about pressure care and staffing. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this full report.

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.

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 will continue to monitor the service.

We have identified breaches in relation to risk management and the quality monitoring systems within the service. Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Cann House Care Home is a residential care home providing personal and nursing care. The service is registered to support a maximum of 62 people. There were 44 people living at the service at the time of the inspection.

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

When we inspected the service on the 11 July 2020, we found people were not fully protected from the risks of infection. At this inspection we found improvements had been made. Senior staff had undertaken updated infection control training and all staff had either completed or were due to complete this training.

Staff had access to government guidance and the home’s policies and procedures relating to infection control and the use of personal protective equipment (PPE). Staff were following this guidance and had the equipment and information they needed.

Hand-washing facilities were available, and staff understood the importance of hand-washing to reduce the risks of infection.

The provider and registered manager had reflected on the concerns raised at the previous inspection and had made changes to infection control practices with support and guidance from the specialist infection control team.

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 Good. (Published 16 August 2018)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met on a specific concern we had about infection control practices. The overall rating for the service has not changed following this targeted inspection and remains Good.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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.

Cann House Care Home is a residential care home providing personal and nursing care. The service is registered to support a maximum of 62 people. There were 47 people living at the service at the time of the inspection.

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

We found the registered manager had responded to concerns raised in relation to staff not wearing surgical masks as part of personal protective equipment and as required under Government (COVID-19) guidance. At the time of the inspection we found all staff were wearing appropriate surgical face masks as required. However, people were not fully protected from the risks of infection because staff were not consistently following government guidance in relation to personal protective equipment (PPE) or the homes policies in relation to infection control practices.

Following the inspection, the management team and staff received advice, guidance and training from the local authority and specialist Infection control team.

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

Rating at the last inspection:

The last rating for this service was Good. (Published 16 August 2018)

Why we inspected:

The inspection was prompted in part due to concerns received about how staff were carrying out infection control procedures. A decision was made for us to inspect and examine those risks.

CQC have introduced targeted inspections to follow up on a Warning Notice or other specific concerns. They do not look at an entire key question, only part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to check on a specific concern we had about infection control.

We have found evidence that the provider needs to make improvements. Please see the Safe section of this report.

We have been told by the provider that action has been taken to mitigate omissions found. The registered manager sent through information that had been taken following the site visit. This included seeking support from other agencies in relation to Infection Control practices.

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 will continue to monitor the service and to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment.

You can see what action we have asked the provider to take at the end of this full 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 request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

When we inspected the service in September 2016 we found significant concerns in relation to people’s care and the running of the service. The service was rated as Inadequate overall and was placed in special measures. A condition was placed on the provider’s registration instructing them to provide the Care Quality Commission with a monthly report about how they were addressing the concerns raised and how they would improve and meet the regulations. We inspected the service again on the 16 and 17 May 2017 and found significant improvements had been made in all areas. Due to this improvement the conditions placed on the provider’s registration was removed. We found some improvements were still needed in relation to medicines, care planning and leadership, however, we could see that these areas were being addressed and improvements were still being embedded into the culture and running of the service. We rated the service as Requires Improvement at the May 2017 inspection.

At this inspection we found improvements found at the last inspection had been sustained and further embedded in the culture and the running of the service.

Cann House 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 and nursing care for up to 61 people. On the day of the inspection 47 people were living in the home. The service also provides assessment and rehabilitation to some people when they are discharged from hospital. This would normally be for a period of six weeks and is known as ‘Discharge to Assess (DTA). At the time of the inspection the service had 10 DTA beds, and five were occupied. The assessment and rehabilitation of people staying in a DTA bed was overseen by a DTA team, which included physiotherapists and occupational therapists. We spoke with the DTA team during the inspection and their feedback is detailed within the report.

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.

People now lived in a service with good leadership. The providers caring values and commitment to improvement were embedded into the culture and staff practice. People, relatives, external professionals and staff spoke very positively about the management of the service. The registered manager also had a committed and passionate attitude about the service, the staff, but most of all the people. Staff spoke of their love for the people they cared for, and their passion for working at the service.

Staff knew people well, and were able to tell us about their care needs and how they needed to be delivered. Staff were well trained and knowledgeable about people’s health and social care needs and this was reflected in the practices we observed. People told us they felt their care needs were understood and well met by staff. However, some of the written information about people’s care arrangements still required some further improvement to ensure the care being delivered continued to be personalised and consistent.

Nursing staff were available to oversee and support clinical practice, and individual staff members undertook specific training such as end of life care and moving and handling. All staff were valued and encouraged to share and develop their knowledge. For example, each month a staff member produced an information board about a certain area of care, such as oral hygiene and recognising signs of sepsis, and this was displayed in the main hallway for people, staff and visitors to see and gain information from.

People told us they felt safe living at Cann House. People were protected from abuse and avoidable harm because staff had been trained and knew what action to take if they suspected someone was being abused, mistreated or neglected. Staff were recruited safely to ensure they were suitable to work with vulnerable adults. The provider ensured the environment was safe for people to live in. Regular checks were undertaken and the equipment used by people was maintained to ensure it was safe and fit for purpose. People were protected by the provider’s infection control procedures, which helped to maintain a clean and hygienic environment.

People who had risks associated with their care had them assessed, monitored and managed by staff to ensure their safety. People’s safety was very important to the provider and staff. When things went wrong the provider learnt from mistakes and took action to make improvements. People received their medicines safely and staff undertook regular competency tests to help ensure they had the skills required to support people safely with their medicines.

People received an organised and coordinated approach to their health and social care needs. People had access to external healthcare professionals to ensure their ongoing health and well-being. The registered manager and provider also worked closely with the local social and healthcare services to support people to return home following a stay in hospital. Feedback from other agencies about the outcomes for people staying for a period of rehabilitation was very positive. Staff were also trained and skilled in providing good and dignified end of life care, which supported people to stay in the home during their last days and prevented re-admissions to hospital.

People were asked for their consent and staff acted in accordance with their wishes. Where people appeared to lack capacity, mental capacity assessments were completed and involved the person, their family and professionals in best interest decision making.

People were supported to eat a nutritious diet and were encouraged to drink enough. At the time of the inspection people were experiencing very hot weather conditions. Staff made sure everyone had access to fluids and monitored people’s fluid intake to reduce any risks of dehydration.

People had access to a wide range of social opportunities. Relatives were welcomed and encouraged to join in social events. As well as responding to people’s changing needs the service worked in innovative ways to enrich people’s lives and experiences. Intergenerational experiences were promoted by inviting children from local schools to visit the home and to spend time with people and to join in events in the home. Two people had also visited a local school to join in with an event. This aimed to connect the generations and create a sense of well-being for both young and old alike. The activities coordinator had worked hard to build positive relationships with the local community, which they believed would impact positively on people and help prevent social isolation.

The provider had robust quality monitoring arrangements through which they continually reviewed, evaluated and improved people’s care. Complaints, concerns, feedback and the monitoring of accidents and incidents were used as an opportunity to learn lessons and improve the service.

We have made a recommendation about personalised care planning.

Cann House provides nursing care and accommodation for up to 61 people. On the day of the inspection 51 people were living in the service. The service also provides assessment and rehabilitation to some people when they are discharged from hospital. This would normally be for a period of up to six weeks and is known as ‘Discharge to Assess’ (DTA) At the time of the inspection the service has 10 DTA beds, and seven were occupied. The assessment and rehabilitation of people staying in a DTA bed is overseen by a DTA team, which includes physiotherapists and occupational therapists.

At the last inspection on the 20, 21, 26 September 2016 we found significant concerns relating to medicines, risk, infection control, healthcare, privacy and dignity, care planning, complaints and leadership. We rated the service as inadequate overall. In line with our enforcement policy we made the decision to place conditions on the provider’s registration. We told the provider they must send us monthly reports to tell us about their progress to address the concerns raised. This condition would remain in place until we are satisfied sufficient improvements have been made.

The service has also been in Special Measures. Services are placed in special measures when they have been rated as inadequate overall. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, the service is now out of special measures.

At the time of the September 2016 Inspection 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 person’s’. Registered person’s 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 registered manager has now left the service and a new manager has been appointed. At the time of this inspection the new acting manager was in the process of registering with the Care Quality Commission. We have referred to this person as the ‘acting manager’ throughout the report.

Following the last inspection in September 2016 we requested that the provider sent us monthly reports on their progress to address areas of concern we had found. We received reports as requested and also met with the provider and Plymouth City Council to discuss the action taken to improve the quality and safety of services provided to people at Cann House. The quality monitoring team for Plymouth City Council told us the provider and acting manager had worked closely with them and had been open and responsive when discussing the concerns found and action needed.

People, relatives and other agencies said they had seen improvements in the service during the last six months. Comments included, “They are doing a good job”, and “They have kept us updated and reassured us that improvements are being made”. The acting manager said they had spent time with staff discussing the concerns found at the last inspection and had considered what factors may have contributed to these failings. They said they had involved all the staff in these discussions and listened carefully to their views and feedback. The acting manager said they recognised the changes were work in progress, but felt positive progress had been made so far. Staff said improvements had been made and they felt more valued and involved in decisions about the service. Staff said they were very happy working in the home, and comments included, “Definite improvement since the new manager took over, morale is way up”, and “ There has been a change in the culture, we are working together as a team, everyone wants the service to improve and we are working together to do that, it is a joint responsibility”.

At this inspection we found improvements had been made. The acting manager had prioritised areas they had considered to be of highest risk, and had addressed these within agreed timescales. They said they were aware further improvements were needed and were working closely with staff to embed some of the changes and working practice.

We found significant improvements had been made in relation to the management and administration of medicines. The acting manager and senior staff had been working with the supplying pharmacy and the CCG (Clinical Commissioning Group) medicines team to improve the way medicines were stored, administered and managed. We saw that there were still some problems with the supply of medicines and some improvements were still needed in the homes ordering systems to help further ensure people were safe and received the medicines they needed. The provider was aware of this issue and was in the process of taking action to address.

Improvements had been made in the risk assessment process, and we saw all risk assessments had been reviewed and updated. However, some risk assessments still needed further improvements when risks had been identified in relation to people’s mental health and well- being.

People’s care plans had been reviewed and most care plans we looked at included clear information about their needs and how they would be met. However, some plans still needed further improvement to help ensure the care provided was personalised and consistent. For example, one plan we looked at said the person needed “total support” in the bathroom, but did not describe how this care should be delivered. Although staff had good knowledge about this person’s needs the absence of written records and guidelines could result in care being delivered inconsistently and not in a way the person chose and preferred.

People were assured a better quality of service due to the new quality assurance programme. Reviews had been undertaken of the homes quality auditing systems and improvements found in the service demonstrated these were now more effective. However, we found some gaps in care records relating to people’s risks and some care records were not sufficiently personalised. These gaps had not been picked up by the homes quality monitoring processes and therefore required further improvement.

People said they felt safe living in the home and relatives said their loved ones were kept safe.Staff had updated safeguarding training and said they felt confident and competent to raise concerns if they felt people were at risk. The acting manager had spent time with staff empowering them to voice any concerns and information was available around the home about locally agreed safeguarding procedures.

People said they felt there were enough staff to keep them safe and said although there were busy times of the day call bells were nearly always answered in a timely manner. Staffing levels had been reviewed, and additional staff had been reruited where the need had been identified. The provider undertook a weekly audit of call bells and took action to address any concerns found.

People were protected by safe infection control practices. The home was found to be clean and well-maintained. Action had been taken to address concerns raised at the last inspection and this had included the fitting of key pads to the sluice room. This helped ensure people were protected from the risk of cross infection or by access to hazardous substances and equipment.

People’s health and dietary needs were met. People had access to a range of healthcare professionals and the feedback from other agencies was positive. We were told the staff made relevant referrals and followed guidance and advice. Care records provided staff with good detail about people’s healthcare needs and staff were familiar with this information. For example, skin care was well managed and records provided staff with clear instructions regarding dressing, wound development and progress. People said the food was of a good standard and they were offered choices when requested.

People were supported by staff who had the training and skills to meet their needs. New staff undertook a thorough induction before they started working in the home and then completed regular training relevant to their role and the needs of people they supported. Staff said they felt supported by their colleagues and management and were able to raise concerns and discuss issues about their practice.

Staff told us how they always asked people for their consent as they provided care, and we observed this in practice. Staff had received training on the Mental Capacity Act (MCA) 2005. The MCA provides the legal framework to access people’s capacity to make certain decisions, at a certain time. When people had been assessed as not having the capacity to make a decision, a best interests decision was made, involving people who knew the person well and other professionals when relevant.

The atmosphere in the home throughout the two days was warm and friendly. We saw lots of caring and compassionate interactions between people and the staff supporting them. Staff told us they loved working in the home and greeted people with a smile and friendly conversation. The environment was bright and welcoming and information was available to let people know what was happening, such as menu’s activity plans and community events. The activities co-ordinator had worked hard to provide a range of activities to meet people’s specific needs and interests. As well as group activities, the activities co-ordinator and staff also spent one –one time with people chatting, reading books or partaking in a particular interest. The home had beautiful gardens, which people could easily access for walks and summer event

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 with six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within the 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.

The 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 longer 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 key questions it will no longer be in special measures.

The inspection took place on the 20, 21 and 26 September 2016 and was unannounced.

Cann House provides nursing care and accommodation for up to 61people. On the day of the inspection 56 people were using the service. Cann House provides care for people with physical frailty, illness or disability.

The service had a registered manager in post. 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.

Prior to the inspection the Commission had received a number of concerns. These included, issues relating to staffing levels, the cleanliness of the environment and the handling of complaints.

We were also told people were at risk as they were not always provided with their prescribed medicines, and needs in relation to skin care, continence, and diabetes were not being met.

At this inspection we found people were not always protected from risks associated with their care because risk assessments were not always in place to provide guidance and direction to staff about how to keep people safe. Known risks in relation to people’s mental health were not always documented as part of their plan. Action had not been taken when people’s mental health deteriorated, which meant people did not receive the help they required.

People’s medicines were not managed, administered and stored safely. The service had introduced a new medicines system, which showed a large number of missed medicines. It was not possible to ascertain if these were actual errors or a problem with the new system and training of staff. Some people had not received their prescribed medicines as required. The management of medicines stock was poor. We found large quantities of stock unsafely stored, which could not in all cases be accounted for. Medicines were not always stored at the correct temperature.

Although infection control policies and procedures were in place, some practices did not protect people from the risk of infection. We found the treatment room to be cluttered and unclean. Bins for the disposal of medicines were dirty and in some cases broken and still in use. Sluice rooms were not lockable and medicines pots had been washed using paper towels and left draining in people’s bathrooms. Insufficient cleaning and poor maintenance of medical equipment could increase the risk of cross infection.

People did not always have sufficient detail in care plans care plans in place to provide guidance and direction to staff about how to meet their needs. Plans to support people with needs associated with diabetes and pressure care did not help ensure appropriate, effective or responsive care. People’s changing healthcare needs were not always referred to relevant healthcare services promptly to ensure they received appropriate care and treatment.

Care plans did not always provide detail about how to meet people’s individual dietary needs. Documentation, which was being used to monitor how much a person was eating and drinking was inconsistently completed, meaning it was not clear if the person was eating and drinking enough.

The provider did not have effective systems and processes in place to help monitor the quality of care people received. Safeguarding procedures had not been followed as required, which meant people remained at risk. Incidents were not always escalated appropriately to ensure people were safe. People were at risk because gaps in records and errors in relation to medicines had not been identified and addressed. The outcome of incidents, investigations and complaints were not always used to drive improvement across the service.

Staff and other agencies said they felt staff were sufficient in numbers. However, people said staff were always rushed and did not have any time to spend just sitting and chatting with them. Some people said this made them feel unwanted and lonely. People said they often had to wait while staff supported people with more complex needs, and this could mean waiting until late morning to get washed and dressed. People and relatives said staff did their best, were kind and caring, but just too busy to give any extra. Relatives expressed concern that people were reluctant to use call bells as they didn’t want to disturb the staff who they knew were very busy.

The provider had a complaints policy, however, people did not always feel their complaints were listened to or taken seriously. Complaints were not always used to improve the quality of the service.

We observed some positive interactions between people and staff when direct care was being provided. However, we saw staff rushing around and not always acknowledging people as they passed them or entered their rooms. Consideration was not always given to people’s privacy and dignity when personal care was provided and people’s personal information was not always protected.

We received mixed feedback regarding the leadership of the service. Other agencies said the registered manager was always open and communicated any concerns appropriately. However, we were told the registered manager did not always demonstrate a consistently positive and professional attitude. We saw the registered manager had considered ways of improving the service. For example, they had introduced a new medicines and care planning system to help improve the quality of the service. However, there was no plan in place to consider staff feedback and to monitor and address issues relating to the system during the implementation stage.

Staff undertook a range of training appropriate to their role. Staff said they had formal supervision but did not always feel listened to or valued by management. Some staff said they felt this had resulted in low morale within the staff team, which they believed would impact on the quality of care provided to people.

Staff undertook safeguarding training, and a safeguarding policy and procedure was in place. However, some of the staff were unfamiliar with the procedures for reporting safeguarding concerns. Staff were not always clear about how to report safeguarding concerns outside of the organisation.

The registered manager understood their role with regard to the Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards (DoLS). People’s capacity had been assessed in relation to medicines and living in the home. Capacity had not been assessed and documented in relation to other areas of people’s care and lifestyle. We did see staff asking for people’s consent before care was provided.

People spoke highly of the activities coordinator and many said they enjoyed the group activities organised in the home. However, some people said the group activities did not interest them and were not available during the evening and weekends. Some of the people who spent most of their day supported in their bedrooms said there was little available to help them occupy their time.

The registered manager had recruited nursing assistants to support qualified nursing staff and to reduce the use of agency workers. They had also been part of a city wide initiative to enhance the training of nursing assistants and to develop this role for the future. One staff member said, “The registered manager was very supportive of me when I did my nursing access course”.

We found breaches of the regulations. You can see what action we told the provider to take at the back of the full version of the report. 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 talked with eight people who lived at the home, eight members of staff and one visitor to the home. They all told us that they were happy with the way they were cared for at Cann House. Their comments included 'I have no complaints' and ' I feel respected as an individual'.

People told us that at all times staff treated them kindly and respectfully. They told us that they were happy with the care they received and said they thought their needs were being met.

People told us that they were happy with the choices and standard of food provided. Changes in how meals were served had improved the overall dining experience.

Medicines were mostly managed safely.

People were cared for by staff who had received training to provide them with the skills to meet their role. People and staff at the home said that there were enough staff available on each shift but they sometimes had to wait. One person told us 'Staff are as good as gold.'

Systems were in place for monitoring the quality and risks associated with the service to ensure that improvements identified were identified and addressed. Everybody we spoke with told us that they could talk to the registered manager if they had any problems and action would be taken.

People who were living in the home said, 'I am very happy indeed' and 'I feel I am being cared for very well'. One person told us that the meals were 'smashing ' and that they had choices of meals. We observed that some staff were better at supporting people to eat and drink than others.

Two visitors to the home said they were always made welcome and were able to bring in the family dog. This helped the person being visited to remain in contact with life at home.

People were complimentary about the caring attitude of the staff. We saw that not all areas of identified need, including risk of falls and changes of position were met by staff.

Regular checks had been carried out to monitor the safety of the home, staffing levels, the completion of care plans and the organisation of medicines to check that everything was in order and that tasks had been completed properly.

People who were living in the home said, 'I've got no complaints' and 'We can do what we want.' One person told us that the meals were good and plentiful and there were always hot and cold drinks available showing that people received sufficient food and drink.

One visitor to the home said 'They make me very welcome. They all work together to care for (my relative).' Another said their relative 'loves it here.' One said, 'They look after her better than they used to, and the care is good when they are fully staffed. People sometimes have to wait when they don't cover for sickness'.

The registered manager showed us the rotas and told us how the staffing had been increased, in particular with shifts that covered the busy times of day.

We found that the house was clean and tidy throughout, and all the equipment we saw was clean. Regular checks had been carried out to monitor the safety of the home, the completion of care plans and the organisation of medicines, to check that everything was in order and that tasks had been completed properly.