Marina Care Home

Marina Care Home provides accommodation and personal care for up to 33 people. There were 13 older people living in the home, including those living with dementia.

Marina Care Home is a large adapted house with 4 floors and lift access to all floors. There is a communal lounge and dining room located on the ground floor. The top floor was closed at the time of inspection.

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

Whist we were assured people received the care and support they required, care records did not always best evidence this. We have made a recommendation about the importance of maintaining contemporaneous records.

The management team had worked hard since the last inspection to improve the standards of care and support and to address the shortfalls found at our last inspection.

Changes had been made to the management team which had helped to strengthen governance processes and improve the safety and quality of care provided.

Risks to people's health, safety and well-being were assessed. Care plans had been updated to ensure staff had access to information about how to manage people's identified risks and support them in a safe way.

Medicines were managed in a safe way and people received their medicines as prescribed.

Safeguarding processes were in place to help ensure people were protected from the risk of harm. Accidents and incidents were analysed to ensure the home had an accurate picture of safety at any given time.

Staff were recruited safely and there were enough staff on duty to meet people’s needs in a timely way. The use of agency staff had decreased since the last inspection, meaning people were supported by staff who were familiar with them and their needs and preferences.

Improvements could be seen in the cleanliness of the communal areas and the home overall.

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 and were followed by the provider in line with the Mental Capacity Act.

People’s feedback about the care and support they received was consistently positive. People were treated with kindness and their privacy and dignity was maintained. The home had a relaxed, calm and friendly feel.

Governance systems were now more robust and operated effectively to ensure regulatory requirements had been fulfilled, to identify concerns and help drive improvement. Both people and staff spoke positively about the support provided by the 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 (report published 9 February 2023).

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.

At our last inspection we recommended that inductions should be provided to agency staff at the start of their shift and that people's support needs should be better reflected in their care plans. At this inspection we found the provider had acted on our recommendations and had made improvements.

This service has been in special seasures since 9 February 2023. The overall rating for this service was 'requires improvement'. However, we placed the service in 'special measures'. We do this when services have been rated as 'inadequate' in any Key Question over 2 consecutive comprehensive inspections.

During this inspection the provider demonstrated that improvements had 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

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also checked whether the warning notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

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 overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

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

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Marina 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.

Marina Care Home provides accommodation and personal care for up to 33 people. There were 13 people living in the home, some who were living with dementia. The building is a large adapted house with four floors and lift access to all floors. The top floor was closed at the time of inspection pending repairs and refurbishment.

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

The management, administration and storage of medicines was unsafe. Risk management was not consistently achieved to protect people from avoidable harm, such as the storage of food thickeners. Not all staff knew how to safely support people if they had to leave the home in an emergency.

Some people’s privacy and dignity was not consistently maintained. Governance systems were not always robust and operated effectively to ensure all regulatory requirements had been fulfilled. Some audits were not consistently completed and failed to either identify concerns or drive improvement.

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 but were not always followed by the provider in line with the Mental Capacity Act.

Agency staff received their induction part way through their shift. We have made a recommendation about this. While staff had knowledge on people’s support needs this was not always reflected in the care plans. We have made a recommendation about this.

The top floor was closed for refurbishment. Improvements could be seen in the cleanliness and homeliness of the communal areas. Observations showed people were happy and relaxed in the company of staff. Recruitment processes had been reviewed and were more robust. People were supported to have access to healthcare professionals. People spoke positively about the food and their nutritional needs and preferences were met. Staff spoke positively about the support they received from the management team.

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 inadequate (published 04 November 2022).

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 the provider remained in breach of some regulations.

At our last inspection we recommended the provider included all relevant information in staff recruitment records. At this inspection we found the provider had introduced more robust systems and had made improvements to their recruitment processes.

This service has been in Special Measures since 04 November 2022. During this inspection the provider demonstrated that some improvements have been made. However, Marina Care Home has been rated inadequate for a second consecutive time in the well-led domain. Therefore, this service remains in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

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

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.

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

Enforcement and Recommendations

We have identified breaches in relation to risk management, working in accordance with the Mental Capacity Act 2005 and consistently promoting people’s privacy and dignity. We identified a breach in relation to the ongoing failure to have effective and consistent governance of the service at this inspection.

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

The overall rating for this service is ‘requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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 of the provider's 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.

Marina Care Home provides accommodation and personal care for up to 33 people. The building is a large adapted house with four floors and lift access to all floors. There were 24 people living in the home, some of whom were living with dementia.

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

People were not safe because not enough suitably qualified staff were available to support them. The former registered manager, deputy manager and several care staff had left the home in close succession. The provider had not ensured agency staff brought in to replace them, had enough information about people's needs to support them safely.

People were not protected from the risk of abuse and avoidable harm because not all incidents had been investigated to avoid reoccurrence. Not all incidents reportable to the local safeguarding authority and CQC had been reported. We found evidence of unhygienic conditions and practices, which placed people at risk of infection. People’s medicines were not always given as prescribed because not enough trained staff were available, improvements proposed in the provider’s action plan from the previous inspection had not been implemented. At the time of inspection, the local authority was actively working with the provider to address safeguarding concerns.

People's needs had been assessed and care plans developed to guide staff on how to support people which included their preferences. However, the electronic care plans were not available to agency staff who made up the majority of the staff team. The provider had not ensured enough information was available for agency staff. Care records were incomplete because either no system was in place for agency staff to record care interventions, or the system in place had not been followed.

People assessed as needing staff support to drink did not get regular drinks. Staff did not keep adequate records of drinks provided. Food was not always served at the correct texture or temperature. We raised these concerns with the provider, who started to address them during the inspection.

Not everyone who was unable to consent to live in the home had a Deprivation of Liberty authorisation (DoLS) in place and there was no system in place to ensure these were applied for and renewed. People’s capacity to make decisions had not been consistently assessed in relation to the use of bed rails and sensor mats.

Staff were caring and interacted with people kindly. However, staff were often very busy and were unable to take time to provide the standard of care and attention people needed, which affected people’s dignity.

Information on people's preferences about their care and life histories had been included in care records. However, people did not receive person-centred care because the information had not been shared with agency staff. People's needs had not been consistently reviewed and some changes in their needs had not been responded to.

The provider had failed to ensure they had oversight of the service. They had not addressed consistent failings in the management of the home in a way that promoted effective care which achieved good outcomes for people. Quality audits had not been completed in line with the provider's policies. The premises were unsanitary and there was evidence of long-term failings to maintain basic cleanliness.

Rating at the last inspection and update

The last rating for this service was requires improvement (published 24 January 2022)

Previous breaches

At the last inspection we found breaches of the regulation in relation to safe care and treatment and governance. 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 not all actions identified by the provider had been completed and they remained in breach of the regulations.

Previous recommendations

At our last inspection we recommended that the provider included all relevant information in staff recruitment records. At this inspection we found some staff records remained incomplete.

Why we inspected

The inspection was prompted in part due to concerns we received about staffing levels, safeguarding and cleanliness. A decision was made for us to inspect and examine those risks. During the course of the inspection we found evidence to support wider concerns and it was agreed to open the inspection to include all five key questions.

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.

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 will take further action if needed.

We have identified breaches in relation to; Safe care and treatment, Medicines, Infection control, Governance, Staffing, Safeguarding people from abuse, Nutrition and hydration, Consent, Person Centred Care, Dignity and Respect.

In response to serious concerns we identified during inspection, we took enforcement action to impose conditions on the registration of the provider using our urgent powers identified under s.31 of the Health

and Social Care Act 2008.

CQC continued to monitor the quality of care at the home through regular meetings with the local authority and with full cooperation from the provider.

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.

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 rating, 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.

Marina Care Home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors. There were 29 people living in the home at the time of the inspection.

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

People and their relatives told us they were safe however; practices did not always demonstrate safe care and treatment. We found medicines were not always well managed. Staff were able to tell us about the risks to people and knew how to support people to minimise the risks. We found recruitment documentation was not always complete, we have made a recommendation about this.

The service was not always well-led. Some records relating to care and the management of the service were either incomplete, inaccurate and/or not kept up to date. We found no impact to people however; this could have compromised the quality and safety of the service provided.

The provider worked with us in a positive manner and provided all the information we requested. Additionally, they responded promptly to our concerns during and after the inspection.

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 13 August 2021).

Why we inspected

We received concerns in relation to infection prevention and control, the management of medicines and documentation. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 good to requires improvement. This is based on the findings at this inspection. We have found evidence the provider needs to make improvement. 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.

We have found evidence the provider needs to make improvements. Please see the safe and well led sections of this full report. The registered provider and registered manager responded immediately during and after the inspection. They confirmed improvements had been made and an action plan was in place to continue the improvements needed.

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 Marina Care 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, documentation, infection prevention and control and governance at this inspection.

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.

The care home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors. There were 29 people living in the home at the time of the inspection.

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

The management team ensured good levels and deployment of staff consistently met people’s needs in a timely way. Recruitment processes remained robust. The building was clean and hygienic with sufficient stocks of PPE, which staff consistently used as per national guidance. Care and support was planned to ensure people’s needs and wishes were taken into account. Risks were assessed and carefully monitored to ensure individuals safety. People received their medicines safely.

People received support with their healthcare and nutritional needs. They 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. There was a programme of staff training and regular updates were in place for staff to improve their skills.

We observed staff interactions with people living in the home and found them to be caring, patient and treated people with respect and kindness. One person said, “Everyone here are so kind and patient, I feel at home.” Another said, "A wonderful place with the nicest people working and running the home."

Activities were varied, staff had worked hard with people to provide meaningful social activities to provide stimulation and exercise. One person said, “Always lots going on here.” There was a complaints process which people and relatives were aware of.

The management team had extensive auditing systems to maintain ongoing oversight of the service and make improvements where necessary. Quality assurance processes ensured people were able to give their views of the service. We found the management team acted upon suggestions to improve the lives of people.

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

This service was registered with us on June 2019.

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.

Marina Care Home 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 care home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors. There were 29 people living in the home at the time of our inspection.

There was 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.

When we carried out a previous inspection in November 2016 we rated the service ‘requires improvement’ in safe, effective, responsive and well-led with an overall rating of ‘requires improvement’. At this inspection we looked to see whether improvements had been made to ensure the provider was meeting the fundamental standards of care. We found the home had made significant improvements to address the issues found in the last inspection.

During the previous inspection we found some areas were odorous and the care provider told us they were in the process of replacing carpets which were heavily stained to eradicate this. During this inspection we observed that the care home had been refurbished to a good standard and had addressed the previous issues. We found the home to be generally clean and free from odours. The manager told us that the refurbishments were still on-going and a number of rooms still required decorating; this was due to be completed within 2018.

We looked at whether the environment was safe including fire safety. During the last inspection in November 2016 we spoke to the fire officer who told us they had served an urgent notice of enforcement to the home which required them to carry out urgent work. We also found that there were hazards posed for people such as not all toilet/bathrooms being easily accessible or having signs. During this inspection we found that home was safe and all work had been completed and they were now compliant with fire safety regulations. All bathrooms had signs and were now easily accessible for people.

There was evidence of regular safety checks being completed by the home and action being taken where issues were identified.

Medicines were being managed and stored safely.

Staff were aware of different types of abuse and how to report safeguarding incidents. Those that were reported had been done so appropriately. They were also aware of the whistleblowing policy. Staff were able to explain how to keep people safe from abuse. People’s individual risks were appropriately assessed and reviewed in order to keep people safe. Staff had received appropriate training in safeguarding.

Staff recruitment files were found to reflect safe recruitment processes. Each file contained an application form with detailed employment history, photographic identification, references and evidence of DBS checks.

Staff had received training in areas such as infection control, health and safety and manual handling.

Accidents and incidents were reported and recorded and showed evidence of analysis and review and action taken where needed.

People living in the home told us they felt safe.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed and Deprivation of Liberty Safeguards (DoLS) applications were completed correctly and in line with current legislation. Staff showed a basic knowledge and understanding of both MCA and DoLS. Best interest decisions were being made appropriately, however we identified that paperwork lacked sufficient detail to show who was involved in the decision making process and what the issues/concerns were.

During the inspection we observed appropriate levels of staff on duty people that we spoke with told us there were staff available if they needed them.

People living in the home spoke positively about the food provided. There was a choice of meals and drinks and snacks were available if requested.

We found people were being supported to access appropriate medical and health care such as; GP, chiropodist, optician and district nurses.

Staff supervisions and appraisals had been completed regularly and were clearly documented. Staff told us they felt well supported by the management team and were able to request additional support through supervisions if required.

We saw evidence of people receiving care that was person centred and based on individual needs and risks. Care files were showed that people (and their relatives) were involved in their care planning and they were provided with choices and were listened to. Care files were reviewed regularly.

We observed staff interactions with people living in the home and found them to be caring and treated people with respect and dignity. Staff were seen to be kind and patient with people. Staff that we spoke to provided good knowledge and understanding of dignity and respect.

In the last inspection we were told by people living in the home that there were not enough activities but that it was improving. During the inspection we saw evidence of activities being provided for people living in the home and people were observed engaging in activities with staff. We saw evidence that an external activities coordinator attended daily and provided both group and individual activities for people.

A complaints procedure was in place for the home and we saw evidence that complaints were dealt with effectively by the manager.

We saw evidence of systems and processes for monitoring the quality and safety of the home and actions being taken when issues were identified.

People living in the home and staff spoke positively about the manager and told us that things had improvement greatly since that last inspection.

The management team were very responsive during the inspection and able to provide information on request.

We saw evidence during this inspection that the manager had worked hard to improve the quality if the service and their continued effort to further improve. Their vision and value was to provide person centred care with happy people in the home and their families whilst keeping people safe. This was evidenced throughout our inspection.

We conducted an unannounced comprehensive inspection on 24 November 2016. We found that the service had made significant improvements and met breaches of the regulations at the time of our inspection. The service has been taken out of special measures and is no longer rated as inadequate.

The care home provides accommodation and personal care for up to 33 people. The building is a large Victorian house with three floors and lift access to all floors.

There were 12 people living at the care home at the time of our inspection. We observed that the first and top floors of the care home were in the process of being refurbished. We were informed by the care provider that they intended to continue to refurbish the care home by also making alterations to the ground floor. There was a newly appointed manager who had been in post approximately four weeks.

A manager was in place and they were currently applying to be registered with us at the time of our 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.

During the inspection we observed the care home was generally clean with some areas which the manager and care provider were aware needed further refurbishment which was already underway. We found some areas were odorous and the care provider told us they were in the process of replacing carpets which were heavily stained to eradicate this.

The service was not always safe. There were hazards posed for people such as not all toilet/bathrooms being easily accessible or having signs and further fire safety improvements were needed. However, work was on-going at the time of our inspection to make the progress required and the fire service were satisfied with the progress being made. There were unpleasant odours in some areas of the care home and further refurbishment needed.

Medicines were being managed and stored safely.

Staff were aware of different types of abuse and had heard of whistleblowing. Recruitment practices were safe and disciplinary procedures were being followed.

Principles of the Mental Capacity Act (MCA) 2005 legislation were being followed with a framework and DOLS applications in place. Staff had basic knowledge but further improvements were needed to ensure staff had a thorough understanding of MCA.

A new training analysis and matrix had been devised and staff were receiving training such as safeguarding and infection control. A new system of online training had been developed for staff. Staff received an induction.

There was a new system in place for staff to receive supervisions and appraisals which needed to be embedded. The manager was working towards this.

People told us they enjoyed the food and we found their nutritional needs were being met. There was a choice of meals and fresh fruit and drinks were available for people to eat and drink when they wished.

We found people were being supported to seek medical assessments and health care professionals input such as chiropody, dietetics and a General Practitioner when they needed.

The staff demonstrated they were caring; we observed staff treated people with respect, dignity and the interactions by staff displayed patience and kindness.

The staff and the manager involved people in their care planning by speaking to them about what they liked or disliked. People were being provided with choices and were being listened to.

The care home environment needed further improvements to be made in order to provide a dementia care friendly environment for people living with dementia.

People were observed engaging in activities with staff and told us activities were improving within the care home since the last inspection.

People's wishes and choices were being adhered to. We found that people were able to choose when they went to bed, when they ate and when they wished to go on trips outside.

A complaints procedure was in place and complaints were dealt with effectively by the manager.

The manager had implemented changes within a very short time frame since arriving at the care home some four weeks earlier and made improvements in all areas of the care home.

Weekly audits were being completed by the care provider who had a good level of oversight of the care home.

The manager and the new senior management team was aware of the risks within the care home and was working towards an action plan to drive improvements and raise morale within the culture of the care home.

People told us they had met the manager and had noticed improvements since the manager came into post. We viewed compliments written by members of the public regarding the improvements within the care home. The manager was well liked by staff and people who lived at the care home.

We undertook an unannounced comprehensive inspection on 31 May 2016 and 1 June 2016 to check that the provider had met the legal requirements identified in ‘Safe’ and ‘Effective’. The provider had not met these requirements.

Located close to Southport promenade and the town centre, Leyland Rest Home provides accommodation and care for up to 33 people. The building is a large Victorian property with gardens to the front and back. The home has three lounge areas, a dining room and lift access to all floors.

Twenty three people were living at the home at the time of the inspection.

There was no registered manager in post. They had left the service shortly before our inspection. A new manager had been appointed and they were planning to register. 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. This happened less than two weeks before the inspection.

People living at the home were not always receiving their medicines as prescribed by the doctor and at a time when they needed them. Medicines were not always stored securely. For example, a person managed their own medicines but the medicines were not stored in their bedroom in a safe way. Plans were not in place for medicines that were given to people when they required them. This was the third consecutive breach of the regulation in relation to the management of medicines.

The way in which mental capacity assessments were undertaken was not in accordance with the principles of the Mental Capacity Act (2005). Applications to lawfully deprive people of their liberty had been submitted to the Local Authority. However, an application to urgently deprive a person of their liberty had not been considered even though the person had left the premises shortly before our inspection. This meant the person was at risk of having their liberty unlawfully restricted if staff tried to prevent them from leaving the building again. This was the second breach of regulation in relation to seeking consent from people.

The staffing levels were inadequate to ensure people’s safety was maintained at all times. The low staffing levels were identified as a concern at our inspection in March 2015. They had improved when we inspected the service in September 2015. Since then the staffing levels had been reduced again.

Care plans were not always being updated to reflect changes in people’s needs and increased risk. Sufficiently detailed care plans had not been completed for people who had moved into the home, including people who moved there over a year ago. For example, a person who moved to the home over 12 months ago still had a ‘mini’ or temporary care plan in place that did not reflect the person’s current needs. There was some confusion about the difference between a risk assessment and a care plan. People and/or their representative were not routinely involved in developing care plans or the on-going care plan reviews.

Although basic information was included in care records about preferred routines and likes/dislikes, staff engagement with people was task-orientated based on the routine of the home rather than person-centred to each person’s specific needs. There were no social or recreational activities for people to participate in. People told us they were bored and just watched television every day.

Care records were disorganised, which made it difficult to locate current information. The service was moving towards an electronic care record system. Staff were not sufficiently familiar with the new system to locate information in a timely way. Paper copy care records were not always held securely and there was a risk they could be accessed by unauthorised people.

Adult safeguarding processes were not robust. We found reported incidents that should have been treated as safeguarding concerns but had not been. Records showed that 50% of the staff team were not up-to-date with adult safeguarding training.

Safe and effective recruitment practices were in place. Staff told us they received regular supervision and an annual appraisal. Staff training was not up-to-date.

We found that areas of the home, most notably bathrooms, were unclean and unhygienic. A detailed risk assessment was not in place to ensure people’s safety was maximised during the refurbishment programme that was underway. We observed a fire door wedged open. This same door had been wedged open at a previous inspection and had not been addressed despite inspectors making the provider aware. The door had been addressed by the second day of our inspection. We could not be confident that wheelchairs were being used safely as we observed most wheelchairs had no footplates in place.

People had access to health care when they needed it, including their GP, optician and chiropodist. A visiting healthcare professional told us staff responded promptly and effectively to guidance and advice given about people’s health care needs.

People expressed mixed views about the meals. Many people told us they were not satisfied with the quality and quantity of food provided at the home. They told us there was no choice to select from prior to each meal.

Staff were caring and kind in the way they supported people. They treated people with compassion and respect. They ensured people’s privacy when supporting them with personal care activities.

A complaints procedure was in place. There was one complaint from 2015 and from the records we could see it had been managed effectively. There were no systems in place to seek feedback about the service from people living there, their families and visiting professionals.

Systems to monitor the quality and safety of the service were not robust. These included checks and audits, feedback systems and the incident reporting and analysis system.

The provider was not informing CQC of all the events we are required to be notified about.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. 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 take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the 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 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

We are taking action to protect people due to the significant concerns found at this inspection and will report on our action when it is completed.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found '

Is the service safe?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service effective?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service caring?

This was a responsive inspection to previous non-compliance against the regulations and we did not look specifically at this area.

Is the service responsive?

Feedback questionnaires for families had been developed and recently distributed. The registered manager advised us that questionnaires would be distributed to people living at the home shortly and staff would provide support to people with completing the forms if they needed it.

We found that the availability of the mini bus had been limited throughout July and August 2014. This meant that alternative transport arrangements had to be made for people to access the community. The planned absence of the mini bus had not been discussed with people living at the home and/or their families. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well led?

Limitations with how the quality of service was being monitored had been addressed since the last inspection. Audits and checks in relation to medication and cleanliness of the premises had been revised and introduced. Plans were in place for the registered manager to develop a care records audit tool.

A consistent view was expressed by the staff that they were not always clear about the roles and responsibilities between the provider and the registered manager. Some staff were uncertain of who was 'in charge' and found it frustrating as they were unsure who to approach with a concern or request. A consistent structure for on-call managerial cover was not in place. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

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

Is the service safe?

We found there was sufficient staff on duty to meet the needs of the people who were living at the home. Arrangements were in place to monitor accidents and incidents.

A range of regular audits and checks were established, including a medication audit and health and safety audit. The audits were not sufficiently rigorous. These meant concerns were not always being identified. For example, the medication audits undertaken each month had not identified that prescribed creams and lotions were being stored incorrectly. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The home protected the rights and welfare of the people in accordance with the Mental Capacity Act (2005). At the time of the inspection nobody who lived at the home was on a Deprivation of Liberty Safeguards (DoLS) plan. Most of the staff team had attended DoLS training.

Is the service effective?

People we spent time with were satisfied with the care and said their needs were being met. Equally, the family members we spoke with were pleased with the care and support their relatives living at the home received. They said staff arranged appointments with health professionals, such as a doctor or dentist if they needed it. Care plans were in place for each person. Care plans were reviewed each month to ensure they were current.

People told us they were satisfied with the food and menus. Any suggestions about changes to the menu were listened to and acted upon.

Is the service caring?

People told us the staff were approachable and responsive if they needed support with a task or activity. One of the people living there said, 'You could not get better than this home. The staff are so good to me.'

Throughout the day of the inspection we observed care staff engaging with people in a positive, respectful and individualised way. Staff had a good knowledge of each person's needs.

Is the service responsive?

People's needs had been assessed before they moved to the home. Records confirmed people's preferences, interests and preferred routines had been recorded, and staff provided support in accordance with people's wishes. People were involved in decisions about their care. They or a family member had signed the care plan. Although people were unable to recall the activities they participated in, family members and staff confirmed activities and trips out took place on a regular basis.

Is the service well-led?

Processes to seek the views of people living at the home were not sufficiently developed. Records were not maintained to demonstrate that people had been involved in in decision making about changes to the home. Opportunities to provide feedback about the service provided at the home were limited. People living there told us about concerns they had reported to staff, such as missing items of clothing, but these concerns had not been fed back to the Registered Manager. This meant people's concerns had not been addressed. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Staff we spoke with said they felt the service was more coordinated and structured since a Registered Manager was appointed. They told us positive changes had been made to the home in recent months. Staff also informed us they received good quality training and had an annual appraisal and regular supervision.

During the inspection we spoke with four people who were living at the home at the time of our inspection. The people we spent time with were relaxed and content. One person said, 'Everything is good here.'

The care records we looked at were individualised and included each person's preferred day and night time routine. Care plans were established and we could see they, along with the assessments, were reviewed each month. Bed rail risk assessments had been completed since the last inspection.

Training had been organised for staff up until January 2014. Staff were receiving regular supervision and appraisal.

Care plans were in place and these were reviewed on a monthly basis to take account of people's changing needs.

An adult safeguarding procedure had been developed for the home and the full staff team had attended safeguarding training since September 2012. In addition, the staff team had also attended training in how to support people with dementia. Overall, mandatory training was up-to-date. The provider had organised further training to address any gaps.

Staff were not receiving regular supervision or an annual appraisal and we have required the provider to make improvements in this area.

The approach to risk management, in particular the recording and management of incidents had been revised and strengthened.

Although assessments and care plans were person-centred, we found that they did not always address each person's full range of needs. Processes were in place to seek the views of people living at the home and or their representatives about the quality of the service.

A consistent recruitment process was in place. However, we heard that staffing levels were low. In addition, staff told us they would benefit from further training to ensure they had the knowledge to effectively meet people's individual needs.

We saw evidence that good quality audits and safety checks were in place. Some of the quality monitoring systems, such as the management of incidents and safeguarding processes were underdeveloped.