Archived: Rowena House Limited

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

Risks to people were not always assessed and managed. Staff were not always aware of the risks to people they supported. Suitably qualified, competent, skilled and experienced persons were not deployed to meet people’s needs at night. Appropriate checks were not always carried out before staff started to work at the service. People’s medicines were not always safely managed.

The providers systems for assessing, monitoring, and improving the quality and safety of the service were not operating effectively. They failed to identify issues we found at this inspection. There were safeguarding vulnerable adults’ procedures in place however the registered manager failed to notify the CQC about safeguarding allegations and police visit in respect of these concerns.

People had individual emergency evacuation plans which highlighted the level of support they required to evacuate the building safely. The provider and staff were following government guidance in relation to infection prevention and control. 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.

Staff said they received good support from the registered manager. The provider took people’s and their relatives’ views into account through meetings and feedback was used to improve the service.

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 7 October 2021).

The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found the provider remained in breach of regulations.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe and Well-led which contain those requirements. The second day of the inspection was prompted in part due to concerns received about potential risks relating to people’s night-time care. A decision was made for us to inspect the home during the night and examine those risks.

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

Enforcement and Recommendations

We have identified breaches in relation to assessing and planning for peoples care needs and managing people’s identified risks, managing people’s medicines safely, protecting people from abuse, recruitment records, training and inducting staff and the overall management of the home.

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

Follow up

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.

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

Risks to people were not always assessed and managed. Appropriate checks were not always carried out before staff started to work at the service. Staff did not always receive training and supervision as is necessary to enable them to carry out their duties. People’s medicines were not always safely managed. Risks in relation to infection control were not effectively assessed or managed.

The providers systems for assessing, monitoring, and improving the quality and safety of the service were not operating effectively. They failed to identify issues we found at this inspection. There was poor oversight of accidents and incidents. There were safeguarding vulnerable adults’ procedures in place. However, the registered manager failed to notify CQC about a safeguarding allegation.

People received support to maintain a balanced diet. Staff supported people with respect and dignity. People were supported to partake in activities that met their needs. The provider had a complaints procedure in place. Residents’ satisfaction and food surveys indicated they were happy with the service they received, and the food provided at the home. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 24 January 2023).

At our last inspection we found breaches of regulations in relation to regulations 9 (Person-centred care), 12 (Safe care and treatment), 13 (Safeguarding service users from abuse and improper treatment), 17 (Good governance), 18 (Staffing) and 19 (Recruitment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We had told the provider what actions they needed to take to ensure the safety of people who used the service. This service has been in special measures since January 2023. The provider was not able to demonstrate that improvements had been made at this inspection. We found the provider remained in breach of these same regulations. The service therefore remains inadequate and continues to be in special measures.

Why we inspected

This inspection was carried out to follow up on actions we told the provider to take at the last inspection. The third day of the inspection was prompted due to concerns received about how care was provided to people in an emergency.

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 and Recommendations

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

Follow up

The overall rating for this service is 'Inadequate' and the service remains in 'special measures'. This means we will keep the service under review. 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.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Rowena House Limited on our website at www.cqc.org.uk.

Rowena House Limited is a residential care home providing personal care for up to 22 people aged 65 and over in one adapted building. There were thirteen people living at the home at the time of this inspection.

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

People were not always protected from improper treatment as inappropriate restraint was used on some occasions to ensure some people remained seated during a meal. People were not always treated with dignity and respect or their equality characteristics considered.

Risks to people in relation to their health or care needs were not always identified or assessed. The provider’s policies and current government guidance was not consistently followed in respect of visiting or discharge from hospital. Some risks in respect of some equipment and premises risks were not identified.

The provider’s quality monitoring system was not effective in identifying or addressing risks to people’s health and safety. The culture of the service was not always empowering or inclusive.

We observed that people were relaxed in the presence of staff and each other. Staff understood how to raise any safeguarding concerns and where to go if they felt these were not acted on by the provider. Relatives were positive about the care provided and told us it was a warm friendly service.

Improvements had been made to the cleanliness and hygiene measures to prevent and control infection risks. Regular infection control audits were completed to ensure these remained effective.

Staff were positive about the way the registered manager led the staff team and managed the home. They said he had made a number of improvements.

Safe recruitment processes were followed. There were enough staff to meet people’s needs. We have made a recommendation for the provider to review their domestic staffing levels to ensure people’s needs are met at all times.

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 14 January 2021).

At this inspection we found some improvements had been made but enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced focused inspection of this service on July 2020. Breaches of legal requirements were found. We imposed urgent conditions on the provider’s registration in respect of infection prevention and control.

We undertook this focused inspection to check they met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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 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 remains 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 Rowena House 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 safeguarding people from abuse, assessing risks, treating people with dignity and respect and the quality monitoring of the home.

Please see the action we have told the provider to take at the end of this report in relation to some of the breaches found.

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

Follow up

We will request an action plan and 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.

Rowena House Limited is a residential care home providing personal care for up to 22 people aged 65 and over in one adapted building. There were fifteen people living at the home at the time of this inspection.

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

Risks associated with the environment were not always managed safely. People did not have diabetic risk management plans in place, where they were living with diabetes. The provider’s systems for monitoring the quality and safety of the service were not always effective in identifying issues or driving improvements.

People were protected from the risk of the spread of infection. We have made a recommendation in regard to following government guidelines around supporting safe visits to the home by family and friends during the pandemic.

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 30 May 2019). The home was inspected but not rated in July 2020, at which time there were two regulatory breaches (published August 2020). We took enforcement action following that inspection which included placing a restriction on further admissions to the home without prior agreement from CQC.

At this inspection we found whilst improvements had been made, further improvement was still required and the provider remained in breach of both regulations.

Why we inspected

We undertook this targeted inspection to check whether the breaches of Regulations 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains Requires Improvement.

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

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 failing to adequately ensure risks to people are managed safely and failing to ensure effective systems are in place to monitor the quality and safety of the service 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.

Rowena House Limited is a residential care home providing personal care for up to 22 people aged 65 and over. Seventeen people were living at the home at the time of the inspection.

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

Staff did not always follow current national guidelines to reduce the risk of the spread of infection during the COVID19 pandemic. Risks associated with the spread of infection were not always safely managed. Risks to people had been assessed but assessment tools had not always been used correctly and did not always help identify when risk levels had increased. Products containing substances hazardous to health were not always stored securely.

The provider had systems in place for monitoring the quality and safety of the service through the use of routine checks and audits. However, audits had not always been effective in identifying issues or driving improvements. The provider’s Nominated Individual (NI) and the home’s manager confirmed they were aware of current guidelines relating to the use of personal protective equipment (PPE) in the home during the COVID19 pandemic. However, they did not pick up on staff shortfalls in this area unless prompted to do so during the inspection.

We have made a recommendation about following national guidelines regarding ventilation in care homes.

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

Rating at last inspection

The last rating for this service was requires improvement (published 30 May 2019).

Why we inspected

We undertook this targeted inspection to check on specific concerns we had about the way in which risks to people were managed at the home. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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

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 identified breaches of regulations at this inspection because the provider and staff were not always managing risks to people safely. The provider’s systems for monitoring the safety of the service had not always been effective in identifying issues or driving service improvements.

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

Follow up

We will 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.

Rating at last inspection: At our inspection on 6 February 2018 the home was rated inadequate overall and was placed into ‘Special Measures’. At our last inspection 20 and 21 September 2018 we noted that improvement had been made and the overall rating for home was ‘Requires improvement’. However, the home remained in 'special measures' because they had been rated as 'Inadequate' in at least one key question over two consecutive comprehensive inspections.

At our last inspection 20 and 21 September 2018 we found breaches of regulations because medicines were not always managed safely, risks to people were not always property assessed, appropriate recruitment checks had not always been carried out before staff started work and the provider’s quality assurance processes were not operating effectively. We also found a breach of regulations because the registered manager in post at that time lacked an understanding of their regulatory responsibilities. They had not identified safeguarding incidents at the service as being potential incidents of abuse, despite similar concerns having been raised with them at the previous inspection amounting to a breach of regulations. Improvement was also required because some people’s end of life support preferences had not been discussed with them or their relatives. At that inspection a new manager had been appointed to manage the home. They had made some improvements in the way the service was operating.

At this inspection we saw that the manager had addressed these breaches and were compliant with the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The manager told us they had applied to the CQC to become the registered manager for the home.

People’s experience of using this service: Risks to people using the service were assessed, reviewed and managed appropriately. People’s medicines were managed safely. There were safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Appropriate recruitment checks were being carried out before staff started working at the home and there were enough staff to meet people’s needs. There were procedures in place to reduce the risk of the spread of infections.

People’s care and support needs were assessed before they moved into the home. Staff had received training and support relevant to people’s needs. People were supported to maintain a balanced diet. 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 support this practice.

Staff treated people in a caring and respectful manner. People’s wishes relating to their end of life care needs had been discussed with them or their relatives [where appropriate] and recorded in their care files. People and their relatives [where appropriate] had been consulted about their care and support needs. People were supported to participate in activities that met their needs. The home had a complaints procedure in place.

The manager had effective systems in place to assess and monitor the quality of the service. They had worked in partnership with health and social care providers to plan and deliver an effective service. The provider took people, their relatives, staff and health and social care professionals views into account through satisfaction surveys and meetings. Feedback from the surveys and meetings was used to improve on the service. Staff enjoyed working at the home and said they received good support from the manager. Management support was always available for staff when they needed it.

Why we inspected: This was a planned inspection based on previous rating.

As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five key questions, it is no longer in special measures.

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

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

As a result of our last inspection in February 2018 we took enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements in order to ensure the home environment was safe; that identified risks to people were safely managed and; to ensure people’s medicines were managed safely. At this inspection we found that whilst the provider had acted to address many of the issues we had previously identified, there remained some shortfalls amounting to a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risk assessment tools, including the Malnutrition Universal Screening Tool (MUST) had not always been used correctly when assessing risks to people. People’s care plans did not always include guidance for staff on how to manage identified risks safely. The provider had acted to improve fire safety at the service but further action was required to reduce the risk of legionella and to ensure the environment was safe.

Improvements had been made to the recording of the administration of people’s medicines and to the provider’s processes for receiving and disposing of medicines. However, we also found prescribed creams were not always securely stored and there continued to be a lack of guidance in place for staff on the support people required to take medicines which had been prescribed to be taken ‘as required’.

As a result of our last inspection in February 2018 we took further enforcement action and served a warning notice on the provider and registered manager requiring them to make improvements to their systems for monitoring the quality and safety of the service. At this inspection we found that whilst improvements had been made to address many of the issues we had previously identified, there remained further areas in need of action, amounting to a continued breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Checks on the safety of the environment had not always regularly been conducted and had not always identified issues in order to drive improvements. Staff had not carried out any audits of people’s care plans in the time since our last inspection which may have helped identify the issues we found with people’s risk assessments. The provider was unable to demonstrate that routine checks had been carried out to monitor for the risk of legionella. Whilst improvement had been made to the process used for auditing people’s medicines, medicines audits had not identified the issues we found in regard to the lack of guidance in place for staff on medicines prescribed to people to be taken ‘as required’.

At our last inspection in February 2018 we asked the provider to take action to make improvements in order to protect people from the risk of abuse because allegations of abuse had not always been reported to the local authority safeguarding team. This action had not been completed; we found details of further incidents which had not been reported to the local authority safeguarding team where required amounting to a continued breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At our last inspection in February 2018 we asked the provider to take action to make improvements to ensure they followed safe recruitment practices. This action had not been completed; one staff member had been working at the service without a criminal records check having been completed. This was a continued breach of regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider completed the criminal records check following our inspection.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

At our last inspection we found improvement was required because the registered manager was not always aware of their legal responsibilities in managing a care home. At this inspection we found continued concerns in regard to the registered manager’s understanding of the responsibilities of their role. They had not acted to fully address four breaches of regulations which we had identified at our last inspection and lacked an understanding of the types of incidents which could be defined as being abuse which prevented them from fulfilling their responsibility to properly safeguard the people living at the home. This was a breach of regulation 7 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

At our last inspection in February 2018, we asked the provider to take action to make improvements because the home was not always clean and some furniture was in poor condition. This action has been completed. Improvements had been made to the cleanliness of the home and new furniture had been purchased which could be more easily cleaned in the event of a spillage.

At our last inspection in February 2018, we asked the provider to take action to make improvements to ensure staff were appropriately supported through a programme of training and supervision. This action has been completed; staff completed an induction when they started work at the service. They received training in areas considered mandatory by the provider and regular supervision to support them in their roles.

At this inspection we found that improvements were required to ensure the details of any accidents and incidents were regularly reviewed in order to look for trends and reduce the risk of repeat occurrence. We also found improvement was required to ensure people’s preferences about the support they wished to receive at the end of their lives had been consistently discussed with them and included in their care plans to help ensure they received the care they wanted at that time.

There were sufficient people deployed at the service to meet people’s needs. Staff wore protective clothing such as gloves and aprons when supporting people with personal care tasks to reduce the risk of infection. People’s needs had been assessed before they moved into the home. The provider used nationally recognised tools and guidance when assessing people’s needs.

People were supported to maintain a balanced diet and told us they enjoyed the meals on offer at the service. Staff supported people to access a range of healthcare services when needed. They worked to ensure people received effective joined up care when moving between different services. People told us that they liked the service’s living environment. The provider had plans in place to redecorate areas of the home and confirmed they would take people’s views into account when the work was carried out.

Staff sought people’s consent when offering them support. 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. Staff treated people with kindness and consideration. People were involved in decisions about their care and treatment. Staff respected people’s privacy and treated them with dignity.

People and their relatives had been involved in the planning of their care. Care plans reflected people’s needs and included information about their likes and dislikes, and preferences in the way they received support. People were supported to maintain the relationships that were important to them. The provider supported people to take part in a range of activities which met their need for social stimulation and engagement. People knew how to complain and expressed confidence that any issues they raised would be addressed.

The provider had recruited a new home manager who had day to day responsibility for the management of the service. They demonstrated an understanding of the Health and Social Care Act 2008 and their responsibilities in managing the service. Staff spoke positively about the support they received from the management team. People, staff and relatives told us the service was well managed and that the new home manager had made improvements since starting work at the home.

Staff told us there was a positive working culture at the service. They attended regular staff meetings and handover meetings between each shift in order to share information about any service developments and ensure they were aware of the responsibilities of their roles. The provider sought the views of people and their relatives, and acted to make service improvements based on their feedback. The management team worked openly with other agencies including local authority commissioners and quality assurance teams.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. This is because the service had been rated as 'Inadequate' in at least one key question over two consecutive comprehensive inspections.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be i

At the last comprehensive inspection in January 2017 we found breaches of Regulations 9, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 due to concerns with the lack of activities on offer at the service, the provider’s practice around managing the risk of people choking, and with the provider’s recruitment practices. Following that inspection the provider wrote to us to tell us the action they would take to address our concerns.

At this inspection, we found that whilst the provider had addressed the individual concerns identified at our last inspection, there remained concerns amounting to breaches of regulations because risks to people were not always managed safely and the provider could not always demonstrate that sufficient checks had been made on the suitability of the staff working at the service.

We also found further breaches of regulations because safeguarding allegations had not consistently been reported to the local authority safeguarding team, furniture in the premises was worn and in need of replacing, and medicines and the risk of infection were not safely managed. Staff were not always supported in their roles through training and supervision, people were not always lawfully deprived of their liberty and the provider’s systems for monitoring the quality and safety of the service were not effective in identifying issues or driving improvements.

You can see what action we told the provider to take at the back of the full version of the report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager had submitted notifications about important events to CQC where required, but we found improvement was required to ensure they understood all of their responsibilities in order to meet legal requirements.

There were sufficient staff deployed to meet people’s needs, although improvement was required to increase the number of staff employed by the service in order to reduce the frequency at which agency staff were used to cover shifts. The provider reviewed records of accidents and incidents to determine whether any changes were needed to the way in which they were supported, but improvement was required to ensure accidents and incidents were consistently reported and recorded.

Staff sought consent from people when offering them support and understood the process to follow in supporting people to make decisions in their best interests where they lacked capacity to do so, in line with the requirements of the Mental Capacity Act 2005 (MCA). People’s needs were assessed and these assessments formed the basis on which their care plans were developed, although improvement was required to ensure care plans accurately reflected people’s individual needs and preferences.

People received support from staff to eat and drink and records confirmed dietary advice had been sought from healthcare professionals, where appropriate, but improvement was required to ensure kitchen staff were aware of people’s individual dietary requirements. People were supported to access a range of healthcare services when needed, and staff acted to ensure people received consistent care across different services.

Staff treated people with kindness and consideration, although improvement was required to ensure people were consistently treated in a dignified and respectful manner. People were supported to make decisions about their care, and their privacy was respected. Relatives told us they were welcome to visit when they wished. People and relatives confirmed they were aware of the provider’s complaints procedure, and records showed the provider had investigated and responded to any complaints raised, although improvement was required to ensure complaints were responded to within the timescales identified in the provider’s complaints procedure.

People, relatives and staff spoke positively about the registered manager and the support they received. The provider sought feedback from people and relatives through the use of surveys, and survey feedback indicated that people were happy living at the home and with the support they received. The service worked with healthcare professionals to ensure people received appropriate treatment at the end of their lives.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

This inspection was prompted in part by a notification of an incident following which a person using the service sustained a serious injury. This incident is subject to a safeguarding investigation and as a result of this we did not examine the circumstances of the incident at this inspection. However, the information shared with CQC about the incident indicated potential concerns about the management of risk of pressure sores. This inspection examined those risks.

We found that assessments had been carried out to assess the risk to people in relation to their skin integrity and pressure sores. Staff checked people daily during personal care for skin redness on pressure areas. Staff told us that any change to people’s skin integrity would be reported to the registered manager and the GP and district nurse would be called to attend the home. We saw that the district nurse had recently been made aware of the high risk to a person using the service developing pressure sores. The district nurse had advised the home to monitor the person skin daily and contact them directly should there be any problems.

At this inspection we found breaches of the regulations of the Health and Social Care Act 2008 (Regulated Activities), Regulations 2014 in relation to safe care and treatment, staffing and person centred care. We found that action had not been taken to support a person where risks to them had been identified in relation to eating and drinking. Appropriate recruitment checks did not always take place before staff started work. People using the service were not receiving person centred care that reflected their needs or their personal preferences. You can see what action we told the provider to take at the back of the full version of the report.

We found the provider had safeguarding adult’s procedures in place and staff had a clear understanding of these procedures. Staff had access to a whistle-blowing procedure and said they would use it if they needed to. There was enough staff on duty to meet people’s needs. People received their medicines as prescribed by health care professionals.

All staff had completed mandatory training in line with the provider’s policy; they were receiving regular formal supervision and, where appropriate, an annual appraisal of their work performance. The registered manager and staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and acted in accordance with this legislation. People were being supported to have a balanced diet and they had access to health care professionals when they needed them.

Staff knew people well and had developed positive caring relationships with them. People using the service and their relatives, where appropriate, had been consulted about their care and support needs. They were also provided with a brochure that included information about the home and the standard of care they should expect. People’s privacy and dignity were respected.

People’s care plans and risk assessments provided guidance for staff on how to support them with their needs. Where people’s needs had changed, their care records were being updated to reflect the changes. People and their relatives knew about the home’s complaints procedure and said they were confident their complaints would be fully investigated and action taken if necessary.

The provider recognised the importance of regularly monitoring the quality of the service. However the registered manager was not aware of some of their responsibilities with regard to the Health and Social Care Act 2014. Some of the homes administration records had not been kept up to date. The provider took into account the views of people using the service and relatives through surveys. They carried out unannounced visits to the home to make sure people where receiving appropriate care and support. Staff said they enjoyed working at the home and they received good support from the registered manager and team leader.

We asked the provider for an action plan to tell us how they would become compliant with this regulation. Prior to this inspection CQC received anonymous information about the service in which concerns about the condition of the premises and the staffing levels were raised.

We carried out this inspection to check that the provider had taken appropriate steps to comply with the compliance action and to follow up on the concerns that had been highlighted.

The inspection team who carried out this inspection consisted of one adult social care inspector. On the day of the inspection there were 18 people using the service. During the inspection, the inspector worked to answer one of our five key questions; Is the service safe?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with four of the care staff, the provider who was also the registered manager and a visiting health care professional. We did not talk with people at the service about the areas we inspected as most people were not able to communicate with us about these issues due to the level of dementia they experienced. We observed interactions between staff and people using the service in the communal areas throughout the day. We looked at records related to the service such as staff duty rosters, staff files and audits. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found inadequate systems were in place to identify risks to people from risks at the premises or risks from inadequate maintenance. Where maintenance was required it had not always been identified and where it had been identified risk assessments had not always been completed to manage and reduce risks to people who used the service.

Appropriate recruitment checks were now in place. We saw there were procedures in place to make all necessary recruitment checks on staff before they started work at the service.

There were sufficient levels of staff employed at the service. We found that the staffing levels matched the staff rota. People's needs were responded to and met in a timely way. New permanent staff had recently been employed and regular agency staff were used where required.

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

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

Is the service safe?

People at the service were not able to express their views to us about this so we used the SOFI (Short Observational Frame work for Inspection) tool to observe the way staff interacted with people. We saw that people appeared relaxed and comfortable in the presence of staff and in the company of others. The atmosphere felt calm and convivial. There was no sign of any distress and interactions were warm and encouraging. People were asked for their consent, and verbal and non-verbal cues were checked for signs of consent or otherwise.

Records we looked at showed that staff regularly reviewed and checked potential risks to people's safety, health and welfare at the service. There was appropriate guidance for staff on how to manage these risks and keep people safe from harm when providing care and support. Staff were aware of safeguarding vulnerable adult procedures and what to do if they had concerns.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, relevant staff understood when an application should be made and how to submit one.

Equipment at the service was maintained and checked regularly to make sure it was safe to use. External service contracts were in place as well as internal checks, most but not all internal checks had been regularly recorded. Issues had been identified with a supplementary boiler and we saw there was an action plan in place to address this. New equipment had been bought where the need was identified.

Staff on each shift were trained to deal with emergencies. The provider was available on call in case of emergencies and there was a contingency plan in place.

However recruitment practices were not always robust. While some checks e.g. right to work, identity and Disclosure and Barring Service clearance were made before staff started work, there were inadequate checks on staff character and employment history. Health declarations were not completed by staff prior to commencing work.

Is the service caring?

Two people we spoke with at the service were able to express their views about the care they received. One person told us 'I am being well looked after.' Another person said 'It is ok here. The staff are nice.' We spoke with a relative of someone who uses the service they told us they were happy with the care provided and said "The staff are lovely, very helpful. Everyone is very caring. I cannot fault it there at all. They have always provided good care and X has been very happy there. We are kept up to date with any changes and invited to reviews."

During our inspection we observed that staff supported and interacted with people displaying patience, respect and warmth. People's consent was sought as much as possible before providing care. People who used the service were appropriately dressed and had been supported with their personal care and choices regarding their meals and activities for the day. We observed that there were enough staff to meet their needs, people were not rushed or seen to be waiting for support. Activities were provided and we saw that staff encouraged people to interact during the day.

People's interests, past history, health needs and their preferences for care and support had been documented and were regularly reviewed. This provided staff with a picture of people's needs and enabled them to engage with people in an appropriate manner.

Is the service effective?

People's care plans provided detailed information to staff about their needs. These were regularly reviewed to check they were appropriate. However, the latest care plan was only available electronically. The provider advised they would print out the plans as a matter of urgency so staff had access to an up to date copy.

The provider had a business plan that was aimed at improving the service. Work was being carried out to improve the flooring and fire safety in the home at the time of the inspection. There was a system of regular checks and audits across aspects of the service. These include health and safety checks and spot checks of night staff.

People who use the service, their representatives and staff were asked for their views about the care and treatment provided within the home, although it was not clear that there was an effective process in place to use all comments to inform any changes.

Is the service responsive?

The provider told us they tried to respond to people's needs as far as possible. For example a person who used the service helped with the trolley at meal times as they had been a chef and wanted to be involved. People's preferences or wishes were responded to as far as possible.

We saw that people's care plans and risk assessments were updated following a fall or other change in their situation. Families or people's representatives were kept informed about any changes and health professionals were contacted if a need arose.

Where problems with equipment had been identified an action plan was in place which was being reviewed.

Is the service well led?

We observed staff undertaking tasks and providing care and support to people in a competent manner. People in the home interacted positively with staff. Most people were unable to express their views to us but our observations suggested that they were content with the care and support they received within the home.

Staff we spoke with were knowledgeable about policies and procedures at the service as well as people's individual needs. They said they had received sufficient training to carry out their work and that they were well supported to do their job. They felt they could bring any issues to the staff meetings. Several commented that the provider was very approachable. One person said 'You can go to them with anything and they will listen.'

At our visit we found that people and relatives were involved in the care and there were suitable measures in place to ensure people's nutritional needs were met. Staffing levels were mostly appropriate and records were maintained adequately in most cases.