Archived: Rossendale Nursing Home

Rossendale Nursing Home is a residential care home providing personal and nursing care to 18 people aged 65 and over at the time of the inspection. The service can support up to 21 people in premises made from two adapted town-houses close to the centre of St Annes.

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

People were at risk of harm because the provider had not ensured risks were assessed and managed effectively. Medicines were not managed safely and properly. We found some shortfalls in relation to infection prevention and control. There were sufficient numbers of staff deployed to meet people’s needs, but the service relied heavily on agency staff, which impacted the consistency of care for people living at the home. We have made a recommendation about ensuring recruitment records are retained in line with legal requirements.

The provider has repeatedly failed to assess, monitor and improve the quality of the service. This left people at risk of avoidable harm.

We saw some positive interactions between staff and people who lived at the home. Staff spoke positively about their work and the support they received from the registered manager.

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 (published 23 December 2020). The service was rated requires improvement for the last three consecutive inspections.

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.

Why we inspected

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.

The inspection was prompted in part due to concerns received about pressure area care, medicines management, safeguarding concerns, falls and risks related to the management of swallowing difficulties. A decision was made for us to inspect and examine those risks. As a result, we carried out a focussed inspection to review the key questions of safe and well-led only.

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

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from requires improvement to inadequate. This is based on the findings at this inspection.

Since the inspection, the risk has been mitigated because commissioners terminated their contract with the service. All service users were moved to alternative placements and no one is currently living at the home.

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 Rossendale Nursing Home on our website at www.cqc.org.uk.

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 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 medicines management, management of risk, recruitment processes and good governance.

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.

Rossendale Nursing Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 29 people.

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

Peoples medicines were not always managed safely. Care plans we looked at did not always reflect the current needs of people at the home. Audits did not always highlight the concerns we found, and staff did not consistently inform the registered manager when processes in place to promote quality were not followed. We received mixed feedback on how the provider engaged with people, relatives and staff. We have made a recommendation about this.

Staff were able to tell us the signs of potential abuse and what they would do to raise concerns. Not all contracted staff who did not deliver direct care and support to people had received safeguarding training. We have made a recommendation about this. Relatives feedback included, “Yes, [family member] is safe there. I am quite happy, relieved she is being looked after.” Agency staff were being employed to maintain safe staffing levels. Staff deployment was structured, with daily handover meetings guiding staff on people’s needs.

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. Communal areas had been redecorated and as a result the décor of the home was significantly improved. Food, drink and snacks were available throughout the day and provided in a way that met people’s needs.

The registered manager worked with healthcare professionals to ensure people's healthcare needs were met. The provider had been working with the local authority towards an improvement action plan. Improvements in care planning and the environment had been noted since the last inspection, but some improvements still needed to be made.

Staff protected people from the COVID 19 virus by following policies and guidelines for preventing the spread of this virus. Staff wore face masks and sought to ensure social distancing was maintained wherever possible. Hand sanitiser was made available around the home for staff and people to use. Visitors and staff were risk assessed and had their temperatures taken. Notices displaying infection prevention guidelines were seen around the home to remind staff of best practices to reduce the spread of the COVID 19 virus.

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 (published 21 January 2020). 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 last rating for this service was requires improvement (published 21 January 2020). The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

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 coronavirus and other infection outbreaks effectively.

We carried out an unannounced inspection of this service on 25 November 2019. A breach of legal requirement was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve 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, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained Requires Improvement. This is based on the findings at this inspection.

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

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 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 the management of medicines and the governance of some paperwork at this inspection.

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

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.

Rossendale Nursing Home provides personal and nursing care to 27 people aged 65 and over at the time of our inspection. The service can support up to 29 people. Rossendale Nursing Home provides single accommodation as well as four double rooms for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room. Rossendale Nursing Home will be referred to as Rossendale within this report.

People’s experience of using this service:

The provider was continuing to improve their risk assessment procedures, although they had not ensured all care records fully guided staff. Relatives told us they were reassured their family members were safe whilst living at Rossendale. A relative said, “I would not leave my [relative] here if she was not safe, but they take that seriously here.” People received their medication on time and as prescribed. The provider revised staff deployment to ensure each person was safe. The registered manager trained staff to protect people from harm or abuse.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. The provider was continuing to improve their mental capacity systems, but they had not ensured all care records fully guided staff. Relatives confirmed staff sought people’s consent to treatment. A relative stated, “We spoke about his needs and preferences, which they respect.” Relatives also told us staff provided healthy meals and choice about what to eat. However, records were not always detailed to guide staff about actions to support them and mitigate related risks. Staff completed a wide-ranging training programme to update their skills and underpin their knowledge. A relative commented, “Yes, the staff are well-trained, they know what they are doing.”

The provider had implemented new systems to enhance oversight of everyone’s safety and wellbeing. However, not all care records fully guided staff, incidents were not continuously reviewed and policies were not all updated to reflect newly implemented procedures. The provider engaged with external organisations and was keen to gain feedback from staff, people and visitors to enhance care delivery.

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:

At the last inspection the service was rated requires improvement (published 10 September 2019).

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 were ongoing and the provider was still in breach of regulations.

Why we inspected:

The inspection was prompted by notification of a specific incident. Following which a person using the service died. This incident is subject to a criminal investigation. As a result, this inspection did not examine the circumstances of the incident.

The information CQC received about the incident indicated concerns about the management of choking risks. We undertook a focused inspection to review the Key Questions of safe, effective and well-led only to examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other Key Questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those Key Questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report. We have found evidence that the provider needs to continue to make improvements.

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

Enforcement

We identified breaches in relation to good governance at our last comprehensive inspection. The registered manager failed to maintain good records of care planning, monitoring and evaluation; risk assessment and management; and service oversight.

We have found evidence that improvements were ongoing and the provider needs to continue with their action plan.

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.

Rossendale Nursing Home provides personal and nursing care to 27 people aged 65 and over at the time of our inspection. The service can support up to 29 people. Rossendale Nursing Home provides single accommodation as well as four double rooms for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room. Rossendale Nursing Home will be referred to as Rossendale within this report.

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

The management team did not have robust systems to assess people’s safety and mitigate risks. They could not be assured control measures effectively reduced risks or if there were any lessons to learn from incidents to maximise care delivery. This did not optimise service scrutiny to address potential and identified issues, particularly because there were gaps in records. Staff were able to describe good practice in preventing abuse and harm and people said they felt safe at the home.

The management team recorded limited information about people’s preferences and how staff should assist them to meet their needs. They did not always document clear strategies to manage each person’s support or evidence they assessed if models of care worked.

The management team did not evidence they assessed the effectiveness of people’s care and whether treatment outcomes were responsive to their changing needs. Their oversight systems did not always ensure the safe management of Rossendale. They could not be assured their actions were effective or if there were any lessons to learn to improve the service.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not always support this practice. The registered manager failed to develop care plans to guide staff to support people with behaviours that challenged the service in the least restrictive approach. They failed to document treatment outcomes and the impact these had on the individual’s care and wellbeing.

The registered manager did not always organise people’s medicines in ways that prevented the risk of errors. During the medication round, we saw the nurse was frequently interrupted, which increased the risk of mistakes. People said they received their medication when prescribed.

We have made a recommendation about medication systems.

The registered manager did not always effectively deploy staff to ensure people were monitored and safe. Those we spoke with confirmed staffing levels were sufficient to meet their needs. A relative commented, “There seems to be ample amounts of staff on duty.” Staff said they had good levels of training to enable them to be confident in the delivery of care.

We have made a recommendation about staff deployment.

The registered manager mitigated the risks to people associated with malnutrition. People confirmed they enjoyed their meals. One person stated, “Great meals and we have a good choice.”

People said they felt staff and the management team were kind, caring and supported them well at Rossendale. A nurse told us, “If residents have their care and are happy, then I’m happy.”

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 01 August 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the safe management, care planning and oversight of behaviours that challenge the service. 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, effective, caring, responsive and well-led sections of this full report.

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

The provider responded immediately during and after the inspection to effectively mitigate the risks.

Enforcement

We have identified breaches in relation to good governance at this inspection. The registered manager failed to maintain good records of care planning, monitoring and evaluation; risk assessment and management; and service oversight.

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.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 25 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

Rossendale is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, both of which we looked at during this inspection.

A registered manager was in place. 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.

At our last comprehensive inspection of Rossendale on 18 and 19 January 2017, we rated the service as Requires Improvement. This was because the home was in the process of making ongoing improvements, which required time to embed, in service management, responsiveness, effective care delivery and people’s safety. We additionally found a breach in legal requirements because the provider had failed to manage people's medicines with a consistently safe approach. The review, storage and auditing of medication was poor. We undertook a focused inspection on 13 September 2017 to follow-up on our findings and observed the registered manager had improved processes and procedures in relation to medication administration. They demonstrated they were meeting the requirements of the regulations.

During this inspection, we found the premises and environment were not always suitable for people who lived with dementia to best optimise their wellbeing. For example, there were no table items to promote a positive meal experience and environmental distraction and sensory equipment was limited. The management team assured us they were purchasing and replacing equipment to improve people’s lives. We will review ongoing developments at our next inspection.

We have made a recommendation the provider seeks guidance about the provision of a dementia-friendly environment.

People we spoke with told us they received their medicines on time and as required. Care files we reviewed contained a medication care plan and risk assessment to guide staff about the individualised and safe approach to each person’s administration.

We observed call bells were responded to in a timely way and people did not have to wait long for assistance. Those who lived at the home told us staffing levels had improved to better meet their requirements. The previous management team had not always confirmed staff were suitable and safe in their former employment. However, we noted the new registered manager was introducing a system to prevent this from happening again.

The local authority’s safeguarding policy and procedures were on display in the lobby of Rossendale. This gave people who lived at the home, visitors and staff information about who to report concerns to.

The registered manager completed risk assessments to guide staff about the mitigation of risk to people who lived at Rossendale. We saw completed accident forms with clear documentation about any injuries and measures introduced to reduce their reoccurrence.

To enhance evidence-based practice, the management team provided staff with a training programme they were required to complete. One staff member commented, “Staff training and all policies are always available.”

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice. Records we reviewed included decision-specific agreement to different aspects of each person’s support.

People told us they had sufficient meal portions and choice of meals. We noted where concerns arose, staff referred these to GPs and introduced special diets to manage weight loss.

Care planning followed a person-centred model and people confirmed they were involved in this process. We observed staff supported their human rights to good levels of family contact and supported them to meet their diverse needs. We found staff consistently engaged with people in a kind and supportive manner. One relative commented, “The staff really care.”

Treatment plans were personalised to people’s different strengths, needs and goals, which were aimed at promoting their independence. Those who lived at the home told us they felt staff were responsive to their expressed needs.

We reviewed the leadership of Rossendale and saw the registered manager was accessible and visible about the home. We found evidence where they acted to address identified issues from surveys, meetings and quality audit systems. A staff member said, “There has been a huge change in the last couple of years and that’s down to [the registered manager] who has been a massive impact since she’s come here. The culture and atmosphere is so much better.”

After the comprehensive inspection in January 2017, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook a focused inspection on 13 September 2017 to check they had followed their plan and to confirm they now met legal requirements.

This report only covers our findings in relation to the latest inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Rossendale Nursing Home’ on our website at www.cqc.org.uk.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 19 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

During this inspection, we found the registered manager was improving processes and procedures in relation to medication administration. This included the implementation of an entirely new system of storage, documentation and oversight. We saw medicines, including controlled drugs, food thickening products and creams, were consistently stored securely.

Staff who administered medicines received medication training. The management team set up two files with information, guidance and policies to underpin staff skills and understanding. We observed the nurse administered medication carefully and followed each person’s associated care plan. New forms and documents had been introduced, such as monitoring charts and risk assessment, which we found staff had fully completed.

The management team undertook regular audits of all medicines and related general procedures. We saw evidence to show action was taken where issues were identified, such as missing signatures on associated records. The registered manager told us, “Where a staff member is omitting signatures on charts, we will discuss this with them as part of their supervision.” The management team worked with the local authority to improve medicines procedures. This showed the registered manager had good oversight systems and worked with other organisations in the improvement and safe administration of people’s medicines.

Rossendale provides nursing care and support for a maximum of 27 older people who may be living with dementia. At the time of our inspection there were 19 people living at the home. Rossendale is situated in a residential area of Lytham St Annes close to local amenities and the promenade. There are four double rooms available for those who wish to share facilities, which include privacy screening. Communal areas consist of three lounges and a separate dining room.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 15 June 2016, we rated the service as Inadequate and placed it in Special Measures. This was because breaches of legal requirements were found. The provider failed to ensure the environment was safe. They had not always assessed risks to people's health and safety. The provider had not done everything reasonable to mitigate risks, such as maintaining good infection control practices. They had not safeguarded them from abuse and improper treatment. People who lived at the home did not always have comfortable, well-maintained accommodation. Care plans had not been designed to reflect individual needs and people were not always treated with dignity and respect. Signed consent to care was not consistently obtained. Sufficient numbers of suitably qualified, competent, skilled and experienced staff were not always deployed. The registered person had not implemented effective systems to assess, monitor and improve the quality and safety of the service provided. They did not have thorough recruitment processes to safeguard those who lived at the home from the employment of unsuitable staff.

We additionally made recommendations for the provider to further improve people’s safety and welfare. These concerned tools to enhance safe medication recordkeeping, providing more personalised activities and the management of complaints.

During this inspection, we found the provider had made a number of improvements following our last inspection. They worked transparently and collaboratively with local authorities, staff, people who lived at the home and relatives as part of their improvement requirements. The management team enabled everyone at Rossendale to feel a part of the improvement drive. One staff member said, “It was a good home and I want to help it get back to what it was.”

When we discussed safeguarding principles with staff, they demonstrated a good understanding of related principles. Training records we looked at confirmed they had completed relevant training. The provider was implementing new risk assessments and related procedures to protect people from an unsafe environment and inappropriate care. This included fire safety procedures and up-to-date evacuation plans for those who lived at Rossendale in the event of a fire. The home was clean and tidy. The provider had introduced a number of systems to maintain good infection control standards.

The provider had commenced an audit form to check recruitment processes were completed. They had carried out mandatory checks of each employee and their practice requirements to recruit suitable staff. We further noted staffing levels and skill mixes were adequate and deployed well.

We found the management team had implemented regular supervision sessions and a wide range of training to improve staff skills. They underpinned this by assigning staff as champions in a variety of specialist areas, such as health and safety, infection control and dignity in care.

However, we found concerns with how people’s medicines were managed and noted the provider had not followed our recommendation. Staff continued to store creams in bedrooms. We saw records detailed conflicting information, including covert procedures, which did not adequately guide staff. The management team failed to ensure staff always followed national guidance and regulation to protect people from unsafe administration. This is a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Safe care and treatment.

You can see what action we told the provider to take at the back of the full version of the report.

The provider had improved how they obtained consent to care and worked within the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff supported people to make their decisions, such as what they wanted to eat or where they wished to sit. Where applicable, new DoLS care plans outlined the authorised practice and how best to support the individual in the least restrictive way.

We observed improvements in how staff supported people to eat their meals with a caring and encouraging approach. A relative said their family member enjoyed their meals and they were offered choice of what to eat and drink.

Throughout our inspection, we found staff supported people in ways that consistently maintained their dignity. They and the management team were improving their person-centred approach to care in discussion with people and their relatives. A relative said, “I am hopeful for the future of my father’s care.” We observed a quiet, calm atmosphere throughout the home.

The provider was visible within the home and had a good rapport with people and their relatives. The management team held monthly meetings with them to discuss new systems and to listen to their concerns or improvement ideas.

We saw the provider was working closely with the local authorities as part of their improvement requirements. In response to this and the concerns we found at our last inspection, the provider had introduced a number of systems. These assisted the management team to gain a good oversight of quality assurance and environmental safety. Staff told us they felt a part of the ongoing development of the home. One staff member said, “The changes are a great improvement.”

The Rossendale Nursing Home is registered to provide personal and nursing care for up to 27 adults, including those who are living with dementia. The home is a detached Victorian property situated in a residential area and within easy reach of shops and local amenities. A small number of double rooms are available for those who wish to share facilities. Communal areas consist of three lounges and a separate dining room. Parking spaces are limited, but on road parking is permitted in the surrounding area.

The last comprehensive inspection of this service was conducted on 25 January 2016, when improvements were identified as being required in relation to cleanliness and infection control, safety, the management of medicines and monitoring the quality of service provided. These shortfalls were incorporated in the planning of this inspection.

At this inspection we identified numerous areas where improvements needed to be made, which are detailed within each relevant section of the report.

People who lived at Rossendale Nursing Home were not adequately safeguarded from abuse and therefore their safety was not always protected. The recruitment practices adopted by the home were not sufficiently robust, to ensure all employees were fit to work with this vulnerable client group.

We identified several areas of the home which presented potential risks to those who lived at Rossendale and therefore people were not always protected from harm.

There seemed to be sufficient staff on duty on the day of our inspection and it was observed that staff were always present in the communal areas of the home. However, people told us that there had been shortfalls in the staffing levels, but these had recently been increased. Records showed that there was a high level of agency staff used in order to maintain the current staffing levels.

The staff team had received training in safeguarding adults and whistle-blowing procedures. However, refresher training was overdue for a good number of staff members. Some records we saw, which related to people’s monies were poorly kept and did not sufficiently protect individual’s finances.

The management of medicines was, in general satisfactory. We identified a small number of areas, which could have been better. We made a recommendation that medicines procedures continue to be reviewed and improved in line with the NICE guidance ‘Managing Medicines in Care Homes.’

Some areas of the home could have been cleaner and more hygienic. Infection control practices could have been better. This constituted a continuing breach of regulation.

The risk assessment in relation to fire safety was not always being followed in day to day practice and the Personal Emergency Evacuations Plans (PEEPs) needed to be updated. We have made a recommendation about this.

Care plans did not always reflect people’s assessed needs and some information provided was vague and not specific to the care and treatment of those who lived at the home. This did not give the staff team clear guidance about how individual needs were to be best met.

Some care files reflected people’s preferences and what they liked to do and needs assessments had been conducted before people moved into the home.

Deprivation of Liberty Safeguard (DoLS) applications had been submitted, in line with the requirements of the Mental Capacity Act. Records showed that people’s mental capacity had been considered. However, the Mental Capacity Assessments were not always decision specific. Formal consent had not been obtained from the relevant people before care and support was provided.

The management of meals could have been better organised and people who required assistance could have been better supported.

The majority of staff we spoke with had a good understanding of the support people required and were able to discuss their needs. The staff team were well supported by the manager of the home, through the provision of information and supervision.

Complaints were, in general being well managed. Records showed that people's views about the quality of service provided were sought in the form of surveys and meetings.

The provider had not always forwarded the required notifications to CQC. We identified two incidents, which should have been referred under safeguarding procedures, but had not been. The system for assessing and monitoring the quality and safety of the service provided was not effective. This did not allow for shortfalls to be identified and improvements to be made.

We found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 for person centred care, dignity and respect, need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, premises and equipment, good governance, staffing and fit and proper persons employed.

We are taking enforcement action against the service and will report on that when it is complete. As the overall rating for this service is now inadequate, the Care Quality Commission (CQC) have placed the home into special measures and further enforcement action has been taken. Our guidance states that services rated as inadequate overall will be placed straight into special measures. We want to ensure that services found to be providing inadequate care do not continue to do so. Therefore, we have introduced special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate

care significantly improve.

• Provide a framework within which we use our

enforcement powers in response to inadequate care and

work with, or signpost to, other organisations in the

system to ensure improvements are made.

•Provide a clear timeframe within which providers must

improve the quality of care they provide or we will seek to

cancel their registration.

Where we have identified a breach of regulation during inspection which is more serious, we will make sure action is taken. We will report on any action when it is complete.

You can see what action we told the provider to take at the back of the full version of this report.

People who lived and worked at the home were fully aware of the lines of accountability at the home. Staff spoken with felt well supported by the management team, however, we believe that others who contacted us following our inspection were not. (Following our inspection visit, we were contacted by three people who we classified as whistle-blowers.) The systems operated within the home relating to how information was processed and how systems were audited needed improvement. Having robust systems in place will assist staff to identify areas of service delivery that require improvement and mitigate risks. Engagement with the staff team by the management team, in order to determine how best to resolve the issues linked to staff support, will support the processes linked to the reporting of concerns regarding quality issues.

There were systems in place to ensure people's needs were assessed, and their care planned for. Greater effort was needed to ensure that when charts and recording tools are used to monitor various aspects of people's health, these are completed in a timely manner to ensure that clear health care records are maintained. Activities linked to people's assessed needs, abilities and interests need to be improved. People were able to express their choice in relation to meals and how they spent their time. People knew how to access the complaints process, and knew who to talk to if they wanted to raise a concern.

People were treated in a kind, caring and respectful way. There were systems in place to ensure people were involved in their own care planning and support. The training records showed that staff had received awareness training on the subject of end of life care. If people were found to be in need of end of life care, there were systems in place to support this.

Staff had access to on-going training and supervision to meet the individual needs of the people they supported. However, this needed to be improved to ensure that all staff received the support they needed to ensure they could perform their role effectively. The service had policies in place in relation to the Mental Capacity Act 2005 (MCA) and depriving people’s liberty, and these were put into practice. The menu offered people a choice of meals and their nutritional requirements were met. Some areas of the building were in need of repair or renewal, and we recommend that a full review of the building takes place to ensure the environment is safe and fit for purpose.

The service had procedures in place for dealing with allegations of abuse. Staff were able to describe to us what constituted abuse and the action they would take to escalate concerns. Employees were asked to undertake checks prior to employment to ensure that they were not a risk to vulnerable people; the records relating to these checks were complete. Risks associated with medicines management, infection control and cleanliness, and environment factors were not robustly assessed. Adequate control measures were not always in place. The registered provider and registered manager needs to ensure that all people associated with the home are given information about how to raise issues, so that they feel confident in doing so.

We found three breaches of the Regulation 12 (safe care and treatment), and one breach of Regulation 17 (good governance) of the Health and Social Care Act (regulated Activities) Regulations 2014. You can see what action we asked the provider to take at the end of this report.