• Care Home
  • Care home

Archived: St Mary's

Overall: Inadequate read more about inspection ratings

8 Eastbrook Place, Dover, Kent, CT16 1RP (01304) 204232

Provided and run by:
St. Mary's (Dover) Limited

All Inspections

27 July 2017

During a routine inspection

We undertook an unannounced inspection of this service on 27 July and 2 and 9 August 2017.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a garden to the rear of the property. At the time of inspection there were 21 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. At the previous inspection the provider told us that they were in the process of appointing a new manager but this had not been done. A registered manager from the provider’s other location was supporting the service two days a week and there were two deputy managers in day to day charge of the service. The two deputy managers supported three inspectors during the first day of the inspection. A registered manager is a person who is 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.

We last inspected this service in January 2017. We found significant shortfalls and the service had an overall rating of requires improvement with an inadequate rating in the well led domain. The service had been rated ‘inadequate’ overall at our inspection in August 2016 and been placed in special measures. As the provider remained in breach of the regulations and there was a lack of leadership the service remained in special measures which required the provider to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection.

At this inspection improvements had not been made and the provider had not complied with all of the requirement notices issued at the previous inspection in January 2017 and further breaches of the regulations were found at this inspection.

The provider had failed to comply with a condition we had applied to their registration requiring them to appoint a registered manager. Although some efforts had been made to register a manager and an application had been sent to CQC this was subsequently withdrawn.

The systems in place to audit the quality of the service were not effective. The provider had not ensured that the requirement notices issued at the previous inspection were complied with. There remained continuous breaches of 5 regulations and 6 further breaches of regulations were identified at this inspection.

Whistle blowers had contacted the Care Quality Commission to inform us that staff were getting people up in the dementia unit from 5 am onwards. We arrived at 7 am; four people were up in the dementia unit and two people were up in the residential unit. Action had not been taken to address this concern and to make sure people had the choice of when they wanted to get up.

People were not protected from harm as the provider had failed to take action to ensure people were safe and report safeguarding issues to the local authority.

Risks to people’s health when they fell were not being mitigated and there continued to be a lack of risk assessments to guide staff how to support people safely. People were at risk of choking however, detailed risk assessments were not in place to ensure that staff had information to support people with their meals and drinks.

People sometimes displayed behaviour that challenged and were at risk of harming themselves or others. The deputy manager had implemented behavioural risk assessments to give staff guidance on how to positively support people with their behaviour. However, the assessments lacked information on what may trigger the behaviours and how to reduce the risk of them happening again.

The premises were not being routinely maintained to provide a safe and comfortable environment. The provider had not acted in a timely manner to ensure the repairs and maintenance were carried out to ensure the environment was safe. The garden had not been maintained.

Equipment to support people with their mobility had been serviced to ensure that it was safe; however staff told us one there were issues with a battery on one hoist which was not charging properly. The deputy managers were aware of this but no action had been taken to resolve this issue.

Pressure relieving equipment had not been checked to confirm it was set to the individual setting for each person to reduce the risk of pressure sores.

Concerns were raised with regard to the telephone system not working as this was having an impact of how staff were managing the service. There was limited access to the internet to send and receive emails and the printer was not working.

Accidents and incidents were recorded; but further action had not been taken to ensure the service learnt lessons for the continuous improvement of the service. There was a summary of events but no further analysis had been carried out to identify any patterns or trends, to prevent further occurrences.

Staffing levels were not always sufficient to ensure people received the care they needed. The deployment of staff needed to be reviewed so that sufficient staff were on duty at all times. Staff had not been recruited safely to ensure they were suitable to work at the service.

Medication was not being safely managed or stored securely. Referrals to health care professionals had been made but not followed up to ensure that people were getting the professional guidance and support they needed.

Applications to apply for authorisations to deprive people of their liberty in line with the Mental Capacity Act had been applied for, but in one instance staff had not recognised that a person’s liberty was being restricted.

People told us the food was good and they had enough to eat and drink. The four weekly menus needed to be reviewed as at times the meals were repetitive, such as for four days in a row the main meal was beef and mince. The provider had not ensured that people and staff had the necessary supplies of food and gloves to ensure people received safe and effective care. On occasions the shopping had arrived late and the service had run out of milk and bread. At the time of the inspection they also run out of tea bags and the deputy manager gave a member of staff some of their own money to go to the local shop to purchase a supply.

The provider had not ensured that bed linen and some towels were fit for purpose or suitable for people to use.

Staff interaction was kind and caring but there was a lack of contact from staff when people remained in their rooms. People’s privacy and dignity was not always maintained when incidents occurred in people’s bedrooms.

Care plans were not person centred or detailed enough to ensure consistent care was being provided. When reviews had taken place, in some cases, staff had recorded incidents that had occurred but no action had been recorded. The care plans and risk assessments had not always been updated to reflect people’s current needs.

People were not being supported to follow their interests and take part in social activities of their choice. There were no dedicated activities co-ordinator and activities were limited.

The system to monitor complaints was not effective as complaints had not been recorded. There were no records to show that complaints had been investigated and satisfactorily resolved.

Staff and relatives told us that they thought the care being provided was good but the service was not well led as the provider lacked leadership skills.

The service was not being supported by the provider to ensure that people were receiving safe and effective care. There was a lack of leadership and oversight of the service. The deputy managers in day to day control of the service lacked autonomy, support and skill to be able to manage and provide the service.

The audits carried out by the deputy managers were not effective as they did not identify the concerns raised at this inspection. The provider had visited the service twice in the last six weeks and no formal checks had been made on the quality of care being provided.

Checks on the fire system had been made on a regular basis and fire drills had been completed. There was a personal evacuation plan for each person and an emergency procedure in place. Not all staff had received the fire training they needed to safely evacuate people from the premises.

Since the previous inspection only staff had received a quality assurance survey which was in the process of being collated. The results of the survey last year had not been acted on or summarised or shared with people.

A whistle blower told CQC that there were continuing issues with their wages and mistakes were still being made. They had raised these concerns with the provider who assured them this would not happen again but errors were still occurring.

Although some improvement to records had been made, there remained areas where records were inconsistent and not accurately completed or secure, such as care plans, night checks and accident forms.

Staff told us they were loyal to the people who lived at the service as many people had lived there for several years. They said that improvements to the service were slow but new staff had been recruited which had helped improve their morale. There were concerns about keeping their jobs, the lack of gloves and having to purchase items like food, for the service.

There was an ongoing

3 October 2017

During an inspection looking at part of the service

This inspection was carried out on 03 and 04 October 2017 and was unannounced.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover, with limited parking. Residential accommodation is situated over four floors which includes a separate dementia unit. The service also has its own chapel and a well maintained garden to the rear of the property. At the time of the inspection there were 15 people living at the service.

The service had not had a registered manager in post since April 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this service in July 2017. We found significant shortfalls and the service had an overall rating of Inadequate. CQC took urgent enforcement action to prevent the provider admitting any new people and to request regular action plans and updates about the required improvements. The provider failed to comply with this action and did not send action plans as requested. CQC has taken further action that we will publish in due course.

We received a number of concerns from whistle-blowers and others about people’s safety, care and well-being. As a result we undertook this focused inspection to look into those concerns.

Staff did not have a full awareness of the Mental Capacity Act and Deprivation of Liberty Safeguards as they had not recognised when people's liberty had been restricted. Action had not been taken since the last inspection to make sure people were not unlawfully restricted.

People’s health care needs were not consistently and effectively monitored to make sure they received specialist support when they needed it. When people had lost a large amount of weight they were not consistently referred to the relevant healthcare professionals to ensure people were receiving the professional advice they needed.

Staff had not received regular effective training, supervision and appraisals to support them in their role. The induction was not modelled on current recommended guidance. Agency staff who were used to cover shifts at short notice did not receive an induction into the service. Staff competency was not checked to make sure they were providing safe and effective care.

People were not always supported to have enough to eat and drink and to maintain a balanced diet. People were not involved in deciding what foods were on the menu. There was a lack of basic provisions to enable people to have choices about their meals. There was a lack of fresh vegetables. The stock of produce and ingredients in the stores, fridges and freezers was very low.

The provider had not appointed a registered manager to improve the leadership of the service. A consultant had been employed since August 2017 and they were supporting a trainee manager and a deputy manager. There was a lack of leadership and poor governance systems placing people at continued risk of receiving poor care.

The provider had not taken appropriate action to ensure the service was compliant with the regulations. The provider had not notified the local authority or CQC about two safeguarding incidents which had occurred.

Staff raised concerns with the management team throughout the inspection that they had not been paid correctly. Some staff had not turned up for their shift because they had not been paid. People, their relatives and staff views were not taken into account to continuously improve the service.

The systems for monitoring and checking the quality of care provided were not effective as the shortfalls found at this inspection had not been identified and actioned. Records were not consistently accurate or up to date. The service had not improved since the last inspection despite CQC meeting with the provider on several occasions and signposting the provider to help and support.

We identified a number of continued breaches of regulations and additional breaches. The service was placed into ‘special measures’ following the last inspection and remains in special measures as it continues to be rated ‘Inadequate’.

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.

10 January 2017

During a routine inspection

We undertook an unannounced inspection of this service on 10 and 11 January 2017

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a garden to the rear of the property. At the time of inspection there were 22 people living at the service.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. At the previous inspection the provider told us that they were in the process of appointing a new manager but this had not been done. A registered manager from the provider’s other location was supporting the service two days a week and there were two deputy managers in place. One deputy manager supported the inspectors on the first day of the inspection and the registered provider, and registered manager from the other location, together with the deputy manager assisted the inspector on the second day of the inspection. A registered manager is a person who is 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.

We last inspected this service in August 2016. We found significant shortfalls and the service was rated inadequate overall and placed into special measures. The provider had not complied with the warning notices issued at the previous inspection in February 2016 when the service was rated.

The provider had failed to comply with a condition we had applied to their registration requiring them to appoint a registered manager. There was a lack of risk assessments to guide staff how to mitigate risks when supporting people with their behaviour. There was a lack of hoists to ensure people were being moved safely. Suitable arrangements were not in place in the event of an emergency such as fire. People were not receiving their medicines safely and medicines were not being stored at the correct temperatures.

The provider had not acted in a timely manner to ensure the premises were as safe as possible. Applications to apply for authorisations to deprive people of their liberty in line with the Mental Capacity Act had not been applied for. Detailed assessments were not always thorough to ensure people’s care needs were identified and fully met. People were not being supported to follow their interests and take part in social activities of their choice. The registered provider had failed to take appropriate action to mitigate risks and improve the quality and safety of services. Records were not completed or accurate.

We took enforcement action, placed the service into special measures and required the provider to make improvements. Services that are in special measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. The provider sent us information and records about actions taken to make improvements following our previous inspection. At this inspection we found that improvements had been made in many areas, however there remained areas where further improvements were required.

At this inspection the provider had failed to appoint a registered manager. Although the provider wrote to CQC in September 2016 to tell us their intention was for the registered manager of their other location to apply to be the registered manager of St Mary’s, no application had been received. The registered provider told us that they were continuing to advertise for the role but to date did not have any suitable candidates.

The systems in place to audit the quality of the service were not effective. The provider had not ensured that the requirement notices issued at the previous inspection were complied with. There remained continuous breaches of three regulations and a further requirement notice was issued at this inspection.

The deputy manager had implemented behavioural risk assessments to give staff guidance on how to positively support people with their behaviour. However the assessments lacked information on what may be the trigger for behaviours and how to reduce the risk of them happening again.

Accidents and incidents were recorded; investigation and action had been taken to reduce the risk of further events. Each event had been analysed but further analysis was required to identify any patterns or trends, to prevent further occurrences.

Although people’s mental capacity had been assessed there was still a lack of awareness by staff when applying to the local authority to have people’s liberty restricted.

Since the previous inspection a quality assurance survey had been completed and summarised but the results had not been shared with people and staff. There had been meetings with relatives and staff to discuss the improvements required to become compliant with the regulations. People and staff were given the opportunity to share their views about the service; however there was no evidence to show how these were used to continuously improve the service.

The system in place to record, investigate and resolve complaints was not effective. Not all complaints were being recorded and resolved appropriately.

Although some improvement to records had been made, there remained areas where records were inconsistent and not accurately completed such as medicine records, positioning charts. These issues had been raised at the staff meeting to reiterate the importance of recording what care was being provided.

The registered provider had made progress with repairs and maintenance of the premises. Most of the windows had been repaired. Thermostatic valves had been installed, in the bathrooms to ensure the temperature of the water was within a safe range, to reduce the risk of scalding. Some areas of the premises were in need of painting and redecoration and a plan was in place to address these issues.

Checks on the fire system had been made on a regular basis and fire drills had been completed. The personal evacuation plans for each person had been reviewed but there was no information on people’s behaviour or mobility to show how they could be supported to evacuate the premises in the event of a fire. The complexity of the premises had been noted by the registered manager supporting the service, who had contacted the fire and rescue to discuss how to evacuate the service safely.

Equipment to support people with their mobility had been serviced to ensure that it was safe and additional hoists had been purchased to ensure that people had the equipment they needed to support them with their mobility.

There were eight people who needed the support of a hoist to move. Each person had a risk assessment in place, and the deputy manager had sought advice from professionals and implemented detailed risk assessments. People using bed rails had been reviewed to ensure people had consented for their use and measures were in place to make sure people were safe.

People at risk of choking had detailed risk assessments in place to ensure that staff had information to support people with their meals and drinks. These had been reviewed regularly to ensure that staff had current information if people’s needs had changed.

Staffing levels had been increased to ensure that people were safe and received the care and support they needed. Staff had been recruited safely to ensure they were suitable to work at the service.

The management structure of the service had been reviewed and there were two deputy managers being supported by the registered manager from the other location. The two deputy managers were aware of their roles and responsibilities and were receiving one to one supervision. The provider visited the service weekly and held management meetings to oversee the running of the service. Meetings with relatives and staff to explain the new structure of the service and to discuss the inspection report had been held.

Staff told us that morale had improved and a staff meeting was held to discuss their concerns. They said the deputy manager, who supported the inspectors on the day of the inspection, was approachable and always available to provide guidance and worked really hard to improve the service. They felt that since the new management structure was in place further improvements had been made and they felt more confident about the service. They recognised that funds had been made available to improve the premises but still felt the arrangements in place to pay their wages were not always acceptable. They said they had enough gloves and aprons and were very happy that the hoists had been provided and people did not have to wait to go to the bathroom as staff levels had been increased.

The system to ensure people received their medicines safely had improved. We observed that people were receiving their medicines safely; however, there were some issues with regarding to recording the stock of bulk medicines, the storage temperatures and ensuring all medicine records were signed.

There was an ongoing training programme in place to ensure that staff had received the required training. Specialist training such as epilepsy awareness had also been arranged. All care staff received individual supervision and an annual appraisal to address training and development needs.

People’s health care needs were monitored and they were supported to access health care professionals when required. People’s medical conditions had been recorded in their care plans and care plans had been updated to reflect people’s current needs.

The activities programme continued to be

15 August 2016

During a routine inspection

We undertook an unannounced inspection of this service on 12 and 13 August 2016.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a well maintained garden to the rear of the property.

This service did not have a registered manager in post. The previous registered manager left the service in April 2016. The deputy manager has been acting manager since that time and assisted with the inspection. A registered manager is a person who is 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 the time of inspection there were 22 people living at the service.

At the previous unannounced, comprehensive inspection of this service on 10 and 11 February 2016, a warning notice was served together with three requirement notices. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Although some improvements had been made the provider had not fully complied with the issues raised in the warning notice and one of the requirement notices. These shortfalls will be outlined in the report, together with the improvements made to the service.

There were areas of the premises that were still in need of repair. There was ongoing re-decoration and a plan in place, but progress was slow. Thermostatic valves or a system to regulate the water temperature had been installed, however; bathrooms had not been fitted with restrictors to make sure the risk of scalding was reduced.

The provider had carried out a legionella test which confirmed the water system was safe to use. The two electric pumps in the garden to manage waste water had been repaired and were working. Some windows had also been repaired, but others still remained closed and could not be opened as they needed new sashes to enable them to open safely. There were no timescales as to when this outstanding work would be carried out.

The uneven floor on the third floor had been repaired and new flooring was in the process of being fitted. The first floor shower room was still out of action. The first floor bathroom seat had been replaced and was in working order.

Checks on the fire system had been made on a regular basis and fire drills had been completed, but staff attending these drills had not been recorded to ensure that all staff were included and were fully aware of fire procedures. The personal evacuation plans for each person had been reviewed but there was no information on people’s behaviour or mobility to show how they could be supported to evacuate the premises in the event of a fire.

Equipment to support people with their mobility had been serviced to ensure that it was safe to use. However, during the previous inspection staff had identified that the service required an additional hoist. Staff asked the provider to purchase a new hoist in 2015 but this request had not been actioned at the time of the inspection The provider visited the service weekly and was aware of these issues, but progress to improve the environment and equipment was slow.

There were eight people who needed assistance to move with a hoist and several people who were using bed rails to reduce the risk of falls. The acting manager told us that they had not been assessed by health care professional to ensure the right equipment was in place and people were being moved as safely as possible.

The acting manager was in the process of reviewing all of the behavioural risk assessments as it had been identified that they had insufficient detail to ensure people were supported appropriately with their behaviour. These lacked guidance to show staff how to support people positively when their behaviour challenged themselves and others. There was no information on what may be the trigger for this behaviour and how to reduce the risk of this happening again.

One person was at risk of choking and this had been recorded in their health care notes but the care plan had not been updated to ensure that staff were fully aware of the issues.

Accidents and incidents were recorded, bur further investigation and action had not been taken, for example, when records identified that people were found asleep on the floor in or near their bedrooms. The accidents had not been analysed sufficiently to show that they had looked for patterns or trends, to prevent further occurrences.

There were not always enough staff on duty to ensure that people were safe and received the care and support they needed. Staff had been recruited safely although records for one new member of staff were not available at the time of the inspection.

The provider had carried out interviews for the registered manager’s position several weeks prior to the inspection but no one had been appointed. There was an acting manager, a new deputy manager and a team leader which formed the management team. There were no lines of accountability in place as the members of the management team did not have job descriptions in place. There had been no specific training or supervision to support the managers in their new role. The provider visited the service on a weekly basis and all decisions about the service were made by them. There was no autonomy for the acting manager on the day to day running of the service.

Visiting health care professionals said they were not aware of the management structure. Staff said sometimes they got different guidance from members of the management team.

Staff told us that they did not feel valued by the provider. They said the acting manager was supportive and had worked really hard to improve the service, but the provider did not listen or act on what they said. They had concerns that there was a lack of funds to run the service as the budgets were being cut. They recognised that the premises still needed lots of repairs and they were also concerned that the additional hoist they requested in 2015 had not been provided, which resulted in people having to wait for their personal care or going to the bathroom.

The system to ensure people received their medicines safely had been reviewed; however, there were still shortfalls in the medicines administration, storing and recording. The temperature to store medicines safely was too hot to ensure the medicines remained effective.

Some people’s mental capacity had been assessed; however there was a lack of understanding of the legalisation as not all people who lacked capacity to make decisions or needed continuous supervisions had an application made to the local authority to assess if they required a Deprivation of Liberty in place.

The acting manager had a training programme in place and staff had received the required training, including mental capacity training. Apart from the management team, all care staff received individual supervision and an annual appraisal to address their training and development needs.

People’s health care needs were monitored and they were supported to access health care professionals when required. However, the service had failed to recognise that a person had a medical condition until they had been admitted to hospital after a fall and the information was recorded on the discharge note. The person had been living at the service for six months.

Not all relevant information had been included in care plans to identify people’s medical conditions and to ensure that staff received appropriate training to meet their needs. Regular reviews of the care plans had taken place but the main part of the care plans had not always been updated with people’s changing needs. There was a risk that people were not receiving the care they needed.

The activities programme had not improved since the previous inspection. There were some activities in the dementia unit, on the day of the inspection, however there were no activities in the residential unit.

Although a quality survey had been completed, no further analysis had been carried out to show how any comments or shortfalls had been addressed. Therefore people’s views had not been taken into account for continuous improvement. Records, such as the medicine records, positioning charts and night check forms were not accurate and completed consistently.

Staff listened to what people asked them and responded appropriately. People were not always treated with dignity and respect as, at times, they had to wait to go to the bathroom due to the lack of equipment and staff availability.

The provider had not ensured that the published rating from the previous inspection was on display.

People told us they enjoyed the food and had a choice of meals. Their nutritional needs were assessed to ensure they received a balanced diet.

Staff understood how to protect people from the risk of abuse. Safeguarding training was ongoing and in addition one to one supervision with their line manager so that they were aware how to report any concerns in order to keep people safe. However, there was an incident where the staff had not consulted the local safeguarding team. Staff were confident to whistle-blow to the acting manager if they had any concerns, and were confident that appropriate action would then be taken.

People were supported by their relatives to be involved in the planning of their care. Care plans included people’s preferred routines, their wishes, preferences and

10 February 2016

During a routine inspection

We undertook an unannounced inspection of this service on 10 and 11 February 2016.

St. Mary's is a large detached property providing residential and dementia care for up to 36 older people. The service is located within the town of Dover. Residential accommodation is situated over four floors. There is a separate unit to support people living with dementia. The service also has its own chapel and a well maintained garden to the rear of the property.

This service had a registered manager in post. A registered manager is a person who is 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 the time of inspection there were 23 people living at the service.

The premises was in need of repair and redecoration, and in some areas required action to be taken immediately to ensure that people were safe living at the service. Thermostatic valves or a system to regulate the water temperature was not in place to reduce the risk of scalding, and the electrical wiring safety certificate had expired. It was also identified on the previous legionella test in October 2015 that there was an issue with the water, which had not been monitored or risk assessed. There were two electric pumps in the garden to manage waste water and these had stopped working. Some windows had been repaired but there were others which could not be opened.

Equipment to support people with their mobility had been serviced to ensure that it was safe to use, and plans were in place in the event of an emergency. However, staff had identified that people required access to an additional hoist. The provider was requested to purchase a new hoist, but this request had not been actioned at the time of the inspection.

The majority of these issues had been highlighted in the quality assurance checks made by the registered manager, but the provider had not acted in a timely manner to improve the service, and make sure the premises were safe for people to live in.

Although people’s rooms were checked to look for health and safety issues, there were no environmental risk assessments in place to make sure all areas of the service were as safe as possible. There was an uneven floor on the third floor in need of repair, and there was no risk assessment in place to ensure staff and people were aware of this hazard.

The first floor shower room was leaking and was out of action, together with the first floor bathroom, as the bath seat had broken.

Checks on the fire system had been made on a regular basis and fire drills had been completed, but staff attending these drills had not been recorded to ensure that all staff were included, to ensure they had a clear understanding of what action to take in the event of a fire.

Accidents and incidents were recorded and appropriate action had been taken to look for patterns or trends, to prevent further occurrences.

There were not always enough staff deployed to ensure that people received care and support in an effective and timely manner. People told us they had to wait for staff to respond to their call bells.

Recruitment processes did not fully meet the requirements of the regulations because prospective staff’s conduct at their previous employment had not been verified, and there were gaps in employment histories, which had not been discussed.

Staff told us that they were provided with training but records showed updates of training were overdue for some staff. This could place people at risk of experiencing support that was not current or best practice. The registered manager had carried out an audit of the training required to ensure that staff received the relevant training, and was in the process of arranging for the shortfalls to be addressed.

Staff received individual supervision and an annual appraisal to address training and development needs.

Not all staff had received training in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS), so some staff were not fully aware of the process to support people, who may lack capacity, to make decisions about their care.

We observed the medicines administration and found that medicines were not being recorded or given to people safely. The storage of the medicines also needed to be improved.

Staff listened to what people asked them and responded appropriately. People were not always treated with dignity and respect when staff were completing documentation, and supporting them to eat their meals.

Records, such as the medicine records and food and fluid charts, were not accurate and completed consistently.

People had individual risk assessments with regard to their care and behaviour. Risk assessments to move people safely were detailed to ensure staff had the guidance to move them safely. Assessments were also in place to support people with their behaviour, but in some cases specific details were required to list any known triggers to minimise their future occurrence.

Although there were some activities in the dementia unit, on the day of the inspection, there were no activities in the residential lounge. Although people’s preferred hobbies and pastimes were recorded in their care plans there was no evidence to show that staff were supporting them to participate in the activities of their choice.

Staff understood how to protect people from the risk of abuse. Safeguarding training was ongoing and in addition, staff had one to one supervision with their line manager so that they were aware how to report any concerns in order to keep people safe. Staff were confident to whistle-blow to the registered manager if they had any concerns, and were confident that appropriate action would then be taken.

People, who were able, were involved in planning their care and others were supported by their family. Care plans included people’s preferred routines, their wishes, preferences and skills and abilities. There were review meetings to discuss people’s current support and make any necessary changes in their care.

People were supported to access health care appointments and staff monitored their weights and general health, involving relevant health professionals as required. Staff were familiar with people’s likes and dislikes and supported them with their daily routines. People had access to the food that they enjoyed and their nutrition and hydration needs had been assessed and recorded.

Records showed that the registered manager had investigated formal written complaints and responded to the issues raised. However, some people told us that the staff had not responded when they complained that they had to wait a long time for the call bells to be answered.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

21 February 2014

During a routine inspection

Our inspection of 24 September 2013 found that improvements were needed to ensure that people were being appropriately supported with their nutrition and hydration. We also found that some staff members did not have the skills and competencies to fully meet people's needs. There were shortfalls in the staff training programme to make sure staff had the skills to deliver care and treatment safely and to an appropriate standard.

During this inspection we found that improvements had been made and the provider was compliant.

We spoke with the manager and three senior staff and two other members of staff. We also spoke with ten people using the service and one relative. We found that overall people were satisfied with the service. A relative commented: 'The care is generally good, the staff are very caring'.

We found that since the last inspection the staff training programme including induction training had been reviewed and implemented. The training plan was on-going and staff had completed training in moving and handling and various other core subjects. Staff had been supervised and appraised to make sure they had the opportunity to develop their skills to carry out their role.

We found that the chairs in the dementia unit were soiled especially on the arm rests. We were told by the manager that the provider had agreed to replace the chairs and this would be done in the near future.

At the time of our inspection the provider did not have a registered manager in post.

24 September 2013

During a routine inspection

People told us they were mostly satisfied with their care. They said: 'I suppose I am satisfied'. 'The care is passable". "The care is satisfactory'. Relatives said that they found the staff obliging and professional. Some staff felt the atmosphere at the service was friendly and they would recommend the service.

People told us that the quality of food varied and they felt it had improved during the last few weeks. We found that some people were not being routinely asked their choice and they were not involved in menu planning. We observed that people were not receiving drinks throughout the day to make sure they had enough to drink and did not become dehydrated.

Staff recruitment records showed that new staff had been thoroughly checked to make sure they were suitable to work with vulnerable people.

People and staff told us that the staffing levels in the service could be improved. They said there were times when the service was short staffed and they had to wait for staff to answer their calls for support. We found that there was a training programme in place but some training needed to be updated and there was a lack of induction training for new staff.

18 April 2013

During a routine inspection

We made an unannounced visit to the service and spoke with people who used the service, the manager and to staff members. There were 34 people using the service and we met and spoke with some of them and with some visiting relatives. Everyone we spoke with said that they were satisfied with the service being provided.

People told us they were happy with their care and supported. They said that the staff were kind and caring. People said 'I can do what I like here; the staff are good and help me with what I need". People's health needs were supported and the service worked closely with other health and social care professionals to maintain and improve people's health and well being.

There were systems in place to check that the service was being effectively managed. People told us that did not have any complaints but would speak to a member of staff if they had any concerns.

7, 11 March 2013

During a routine inspection

We found that the provider had not made the improvements required from our inspection of 8 August 2012. The timescales in the action plan dated 28 September 2012 had not been met. The service had made some improvements to people's personalised records as ten of the thirty six care plans had been re-written and updated. There were shortfalls in the quality assurance system and some records were inaccurate, missing and not stored securely. Further improvements were therefore required before compliance will be achieved.

People told us that residents meetings had not been held and they had not received a survey to ask them their views about the service. They said they did not have any complaints and were satisfied with the care being provided.

People told us the staff were polite, friendly and caring. They said that that sometimes they had to wait to get the support that they needed from staff.

People said: "One day the staff were so busy I did not get my breakfast till 09.45". "I can not speak highly enough about the staff, but there is really too much for them to do", People said the staff worked really hard but felt there was not always enough staff on duty. Staff told us that at times they were very busy and they could do with more staff on duty. They said the provider had agreed that staffing levels would increase to address the shortfalls.

8 August 2012

During a routine inspection

Some of the people living in the home were unable to tell us about their experiences. We spent time with the people and observed interactions between the people and the staff.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us

A few people told us that they liked the home and the staff were polite and respectful.

Relatives were satisfied with the service and would recommend the home. They said that the staff were polite, respectful and caring and there was usually enough staff.

There were mixed views from the staff with regard to the staffing levels. Some felt there was not enough staff on duty at certain times while others thought they could cope but they were always busy.

Relatives told us that they were involved with the care of their relative, however care plans did not reflect the individual and personalised care being provided and did not show how risk would be managed.