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Cookridge Court Requires improvement

The provider of this service changed - see old profile

We are carrying out a review of quality at Cookridge Court. We will publish a report when our review is complete. Find out more about our inspection reports.

Reports


Inspection carried out on 29 July 2020

During an inspection looking at part of the service

About the service

Cookridge Court is a care home which provides personal care to people. At the time of the inspection the home was providing personal care to 59 people.

People's experience of using this service:

Following the last inspection in June 2019 the home have made improvements. People and their relatives told us the quality of care had improved and their needs were being met. There were enough staff in the home, and we found call bells were attended to in a timely manner. Medicines were managed safely. Although, we found some creams were not stored correctly this was immediately resolved.

The home had improved their governance systems and regular audits meant ongoing actions had been taken to improve care. Due to these improvements the home is no longer in breach of regulation. Whilst improvements had been made, we need assurances over a longer period that these improvements become embedded and sustained.

Following the last inspection care records and risk assessment records were now more detailed. However, we found some areas which still required improvement. Fluid charts had not always been completed to monitor people’s fluid intake and completion dates for actions taken on audits had not always been completed.

Individual risks were being managed and actions immediately taken to prevent re occurrences. When accidents or incidents occurred, learning was identified to reduce the risk of them happening again. People were kept safe and protected from abuse and avoidable harm. Staff were knowledgeable about people’s needs and this was reflected in care plans and risk assessments.

The registered manager and staff encouraged person centred care to ensure people were treated as individuals. The staff knew how people preferred to receive their care and support.

Infection control procedures were in place to prevent against infectious diseases. During the Covid-19 pandemic the home segregated a unit to provide support to those with suspected or confirmed cases to prevent against further spread of infection in the home. Staff wore the correct personal protective equipment when supporting people and this was available throughout the home.

People and their relatives said the registered manager was approachable and listened to their concerns. Staff had with regular meetings and supervisions to promote feedback and good communications with the management team. One staff member said, “The relationship between seniors and carers is good. You can easily raise your concerns with seniors, and it gets resolved. We ensure there is good quality of care given to our residents.”

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 15 November 2019) and there were four breaches of regulation. We issued requirement notices, for regulation 9, person centred care, 12 safe care and treatment, 18 staffing and 17 good governance.

At this inspection the service had improved and were no longer in breach of the above regulations.

Why we inspected

We undertook this focused inspection in line with our current methodology in the COVID-19 pandemic, to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the key questions safe, and well-led which contain those requirements.

Ratings from previous comprehensive inspections for those key questions were used in overall rating at this inspection.

The overall rating for the service has not changed.

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

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 12 June 2019

During a routine inspection

About the service

Cookridge court is a care home which provides personal care to people. At the time of the inspection the home was providing personal care to 65 people.

People’s experience of using this service:

The service delivered at Cookridge Court has been rated Requires Improvement or Inadequate for the past five inspections, which shows a lack of improvement over a sustained amount of time. For the last four inspections the provider has been in breach of Regulation 17.

The provider failed to assess, monitor and improve the quality of the service and maintain accurate and robust care records. We found shortfalls in recordings; for example, repositioning charts, care plans and audits were not always updated or maintained correctly.

People living in the home were not always protected from possible harm. The provider had not followed their fire policy as staff had not carried out evacuations to ensure people could be evacuated safely from the home.

Risk assessments did not always reflect people's needs. We found assessments had not been updated when there was documentation to suggest a risk was present.

Care plans were in place but not always updated to reflect peoples' current needs and related risks. Appropriate action had not always been taken to follow up on deterioration in people’s health.

The providers rota’s were not clear and the dependency tool used to calculate how many staff were required was at times inaccurate. Recruitment checks were completed on new staff to ensure they were suitable to support people who used the service.

Staff were not always up to date with training the provider made mandatory. Staff were provided with regular supervisions and annual appraisals had been completed to support staff development and any new employees completed an induction programme.

The service was not appropriately decorated or designed to meet all people’s needs. There was no signage, tactile simulation or décor which met the needs of people living with dementia.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People and their relatives told us the staff were kind caring and treated them with respect.

People told us the enjoyed the food and were offered choices. We saw people being offered refreshments on the days we inspected. People took part in activities within the home although activities outside of the home were limited.

People told us they were supported to be as independent as possible. Some people received end of life care and relatives provided positive feedback about the care their relatives received.

People living in the home said they felt safe and there were systems in place to reduce the risk of abuse. Medicines were stored, administered and recorded appropriately.

Meetings took place in the home. Staff told us the management team were honest and supportive. Complaints were managed effectively.

We found four breaches of regulation.

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 22 November 2018) and there were three breaches of regulation. We issued requirement notices, for regulation 11 consent, 12 safe care and treatment and for regulation 17 good governance.

At this inspection the service had improved their medicines management and MCA. However, the provider had not improved their governance systems and records which meant they were still in breach of these regulations.

Why we inspected

The inspection was prompted in part due to concerns received about overall care quality and an unexpected death. A decision was made to bring the planned comprehensive inspection of this home forward to allow us to inspect and examine those risks.

This inspection

Inspection carried out on 13 September 2018

During a routine inspection

Cookridge Court is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Cookridge Court is a residential home providing accommodation for persons who require personal care, some of whom are living with dementia. Cookridge Court has four units which include residential and dementia specialist accommodation. The units are called 'Court suite', 'Grange', 'Iverson' and 'Lawnswood.'

This inspection took place on 13 and 14 September 2018. This inspection was unannounced.

The last inspection of this service took place on 26 January, 1 and 5 February 2018. The service was rated as Inadequate at that time. Following the last inspection, we met with the provider to discuss our inspection findings and we also asked the provider to complete an action plan to show what they would do, and by when, to improve the overall rating of the service to at least 'Good'. At this inspection we found the provider had made some improvements. However, the provider had not taken all appropriate steps to make the required improvements needed and they continued to be in breach of three regulations.

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

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

We found medicines were not always managed safely because people did not always receive their ‘as required’ medicines. Guidance for staff in the form of protocols was not always in place to instruct staff on how to administer medicines and some medicines had not been administered at the correct times. Two clinic rooms were not clean and therefore posed a risk of cross contamination.

At the last inspection we found the provider did not comply with the Mental Capacity Act (2005). The process to evaluate the need for Deprivation of Liberty Safeguards (DoLS) was not always documented and mental capacity assessments were at times inaccurate. At this inspection improvements had been made. However, further work was needed to ensure the provider followed the Act. We found best interest decisions had been completed but not all health professionals had been involved. Capacity assessments had not always been recorded and some assessments had been completed that were not necessary.

We found shortfalls in a number of areas relating to record keeping and audits in the service.

Risk assessments were initially completed, reviewed and changed with people’s care needs. However, we found some risk assessments required further detail to provide clear instructions for staff and to maintain people’s safety.

Initial assessments were completed and we found people had been placed on the units most appropriate to their needs. We found some initial assessments which required further details about people’s specific needs and how best to support them.

Following the last inspection improvements had been made to the security of the home, support for staff including supervisions and appraisals, safeguarding incidents had been investigated and incidents and accidents were being managed effectively.

People living in the home told us they felt safe and staff followed the provider’s safeguarding policy for reporting and acting

Inspection carried out on 26 January 2018

During a routine inspection

Cookridge Court is a 'care home'. People in care homes receive accommodation and personal care under a contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Cookridge Court is a residential home providing accommodation for persons who require personal care, some of whom are living with dementia. Cookridge Court has four units which included residential and dementia specialist accommodation. The units were called ‘Court suite’, ‘Grange’, ‘Iverson’ and ‘Lawnswood.’

This inspection took place on 26 January, 1 and 5 February 2018 and at the time of our inspection there were 87 people living in the home. The provider registered with the CQC in August 2014 and has been rated as Requires Improvement or Inadequate for the past four inspections from January 2015 to October 2017.

The last inspection of this service took place on 17 and 30 October 2017and the service was rated as Requires Improvement at that time. Following the last inspection, we met with the provider to discuss our inspection findings and we also asked the provider to complete an action plan to show what they would do, and by when, to improve the overall rating of the service to at least ‘Good’. At this inspection we found the provider had not taken appropriate steps to make the required improvements and they continued to be in breach of multiple regulations. We also identified new shortfalls in the service which exposed people to the risk of harm and abuse.

At the time of this inspection there was no 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.

We identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, namely Regulations 11(Need for Consent), 12 (Safe care and Treatment), 13 (Safeguarding service users from harm and abuse), 17 (Good governance) and 18 (Staffing). Full information about the CQC's regulatory response to the more serious concerns found during the inspection is added to reports after any representations and appeals have been concluded.

The overall rating for this service is 'Inadequate' and the service is therefore in 'special measures.'

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

Inspection carried out on 17 October 2017

During a routine inspection

Following the last inspection we imposed conditions on the provider’s registration of the service. At this inspection we found the service had met these conditions however, when we last inspected the service we found breaches and at this inspection that there had not been improvements therefore the breaches have remained.

Although most people we spoke to said they received their medicines, we found not all medicines had been recorded, stored correctly and administered at the correct times.

We found infection control issues throughout the home which meant people were at risk of being exposed to harmful products, hazards and possible infection.

The provider did not always comply with the Mental Capacity Act (2005) as the process to evaluate the need for Deprivation of Liberty Safeguards (DoLS) was not always documented and mental capacity assessments were at times in accurate.

We found shortfalls in a number of areas relating to record keeping and audits in the service.

Quality assurance reports identified themes and trends for incident, accidents, safeguards, pressure sores and medicines however, these were not always effective as audits did not reflect all of the actions required.

People told us they felt safe living at Cookridge Court and followed the provider’s policy for reporting and acting on concerns.

Risk assessments were initially completed, reviewed and changed with peoples care needs. Staff were aware of individuals risks and how to support people.

Maintenance checks were carried out in the home to ensure it was safe.

Staffing levels were adequate although the provider’s dependency tool was ineffective as it did not reflect the amount of staff required. Most people living in the home and their relatives felt there was enough staff however; a few people felt this could be increased.

Appropriate checks were carried out to ensure staff working in the service were safe to do so and staff received initial induction programmes, training, regular supervisions and annual appraisals.

People were given a choice of food options however, there were mixed views on the quality of the food.

People living in the home had positive relationships with staff who said they were friendly, caring and respected their wishes. Staff ensured they always offered choice at all times and encourage people to remain independent when their health allowed.

Most information was safely stored in locked cupboards although some personal information had been left in a kitchen and handovers took place in communal areas which did not follow the provider’s policy.

Initial assessments were completed and care plans included people’s preferences and specific needs. These were reviewed and updated when people’s needs changed.

Activities took place within the home although we received mixed reviews on the quality of these.

We observed ‘Call bells’ being answered in a timely manner however, some people said they had to wait for assistance at times.

Most complaints were managed with actions taken to address the concerns and most people felt their concerns would be responded to. Some people living in the home felt their concerns had not been addressed and this was discussed with the regional manager.

People living in the home and staff spoke positively about the current management of the service.

We were informed that the home did not currently have a registered manager as the previous manager left recently and the regional manager was acting as manager until they had recruited into the post.

Regular meetings were held within the home and some of these were with care staff, kitchen staff, and the administration team.

The provider gathered feedback from people living in the home and their relatives with annual surveys and staff team engagement surveys.

Inspection carried out on 31 January 2017

During a routine inspection

The inspection took place on 31 January and 3 February 2017 and was unannounced. We carried out the last inspection in December 2015, where we found the provider was not meeting all the regulations we inspected. We found at that inspection the care plans we looked at were not updated on a regular basis, some sections were not completed appropriately or were inaccurate. We concluded the provider had not taken appropriate steps to ensure staff received appropriate supervision and an appraisal in line with their own policy. We told the provider they needed to take action; we received an action plan telling us what they were going to do to ensure they were meeting the regulations. At this inspection we found the home was still in breach of these regulations. We also found additional areas of concern.

Cookridge Court is situated in the Cookridge area of Leeds close to bus routes and local shops. The home is registered to provide accommodation for up to 96 people who require personal care, of which half may need care due to living with dementia. The accommodation is situated over three floors that are serviced by passenger lifts. All bedrooms are single rooms with en-suite facilities. There are several communal and dining areas and the home has an enclosed garden area.

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

People told us they felt safe. Staff understand how to safeguard people from abuse. People and staff we spoke with expressed mixed views regarding staffing levels. We saw from the rotas staffing levels were based on the provider’s assessment of people’s needs but saw examples of where people’s care could have been compromised. The recruitment process was robust and staff completed an induction when they started work.

Individual risks were not always updated regularly, and sometimes contained contradictory information. People were mostly protected against the risks associated with the administration, use and management of medicines. We found people had access to healthcare services to make sure their health care needs were met. Overall, people lived in a clean, comfortable and well maintained environment.

Staff had completed a range of training; however, some staff training had expired. We saw from the 2016 supervision schedule staff had received supervision but not on a bi-monthly basis as stated in the provider’s policy and five staff member’s appraisal was overdue for 2016.

Most care plans we looked at contained a range of capacity assessments, although consent was not well documented. Staff told us they knew what ‘Deprivation of Liberty Safeguards’ (DoLS) meant, however, they were not immediately clear about the implications of having a DoLS in place, or which people this affected.

We observed the lunch time meal on all the floors and saw the food looked and smelled appetising. However, we saw an inconsistent approach to the monitoring of people identified at being at risk of poor nutrition or hydration and weight monitoring records were not always completed as required. We have made a recommendation regarding the monitoring of people’s food and fluid intake.

Throughout our visit, people were treated with kindness and compassion. Staff had a good rapport with people, whilst treating them with dignity and respect. However, we did see examples that demonstrated staff were not always caring. There was opportunity for people to be involved in a range of activities within the home or the local community.

We found care plans did not contain sufficient and relevant information, which meant people may not receive the appropriate care and support. People were not protected against the risks of rece

Inspection carried out on 13 and 15 December 2015

During a routine inspection

This inspection took place over two days, on 13 and 15 December 2015. Both days were unannounced.

At the last inspection in May 2015 we found the provider had breached several regulations associated with the Health and Social Care Act 2008. We found people’s care plans did not contain person specific mental capacity assessments, applications for the Deprivation of Liberty Safeguards had not been carried out appropriately, care plans were not updated on a regular basis, some sections were not completed or were inaccurate. There were not enough staff to provide support to people who used the service, the provider had not taken steps to ensure staff received ongoing or periodic supervision and an appraisal to make sure competence was maintained. The management of medicines did not protect people from the risk of unsafe care or treatment, risks were not fully assessed for the health and safety of people who used the service and the environmental risks had not been updated. The provider had not taken appropriate steps to ensure people were protected from abuse and improper treatment, complaints were not acknowledged, recognised or handled in accordance with the provider’s complaints procedure and the provider had failed to monitor the quality of the service to identify issues. We told the provider they needed to take action; we received an action plan. At this inspection we found the home was still in breach of two of these regulations.

Cookridge Court and Grange is registered to provide accommodation for up to 96 people who require personal care, included people who are living with dementia. The accommodation is situated over three floors that are serviced by passenger lifts. All bedrooms are single rooms with en-suite facilities. There are several communal and dining areas and the home has an enclosed garden.

At the time of this inspection the home did not have a registered manager, although there was a manager who had been in post since May 2015 and had applied for registration. 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.

We found it difficult to establish if staffing levels were maintained effectively on each floor on each shift. Staff did not receive individualised supervision and appraisal. Staff training did not always equip staff with the knowledge and skills to support people safely. We found care plans did not always contain sufficient and relevant information.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People received their medicines at the times they needed them and in a safe way.

Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. People’s mealtime experience was good and they received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity.

The care plans we looked at contained appropriate mental capacity assessments. At the time of our inspection Deprivation of Liberty Safeguard applications had been carried out appropriately. There was opportunity for people to be involved in a range of activities within the home or the local community.

People had opportunity to comment on the quality of service and influence service delivery. Effective systems were in place which ensured people received safe quality care. Complaints were welcomed and were investigated and responded to appropriately.

Although there had been some improvements since the last inspection, there was still a breach of regulation 9 and regulation 18 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.

Inspection carried out on 5 and 18 May 2015

During a routine inspection

This inspection took place over two days on 05 and 18 May 2015. Both days were unannounced.

At the last inspection in July 2014 we found the provider had breached five regulations associated with the Health and Social Care Act 2008. We found there were not enough staff to provide support to people who used the service, staff members did not receive supervision or appraisals and some training, management of medicines did not protect people from the risk of unsafe care or treatment, complaints were not acknowledged, recognised or handled in accordance with the provider’s complaints procedure and the provider had failed to monitor the quality of the service to identify issues. We told the provider they needed to take action; however, we did not receive an action plan. At this inspection we found the home was still breaching these regulations. We also found additional areas of concern.

Cookridge Court is situated in the Cookridge area of Leeds close to bus routes and local shops. The home is registered to provide accommodation for up to 96 people who require personal care, of which the majority are living with dementia. The accommodation is situated over three floors that are serviced by passenger lifts. All bedrooms are single rooms with en-suite facilities. There are several communal and dining areas and the home has an enclosed garden area.

At the time of this inspection the home did have a registered manager. However, they were no longer in day to day control of the service. 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.

There were not enough staff to keep people safe and staff support provided was not held regularly and did not make sure competence was maintained. People’s care plans did not contain sufficient and relevant information to provide consistent, person centred care and support which included the lack of decision specific mental capacity assessments.

Staff had a good understanding of safeguarding vulnerable adults. However, not all incidents had been reported to the relevant authorities. People were not protected against the risks associated with medicines because the provider did not have suitable arrangements in place to manage medicines safely. Complaints were not investigated and responded to in line with company policies and procedures. The service did not have good management and leadership and people were not given the opportunity to comment on the quality of service and influence service delivery. Effective systems were not in place that ensured people received safe quality care.

Recruitment and selection procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. The applications for the Deprivation of Liberty Safeguards had been carried out; however, people also had their liberty deprived illegally.

People were happy living at the home and felt well cared for. People enjoyed a range of social activities and most had a good mealtime experience. People’s physical health was monitored and appropriate referrals to health professionals were made. Staff were aware and knew how to respect people’s privacy and dignity; however, this was not always observed.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

Inspection carried out on 29 & 30 July 2014

During a routine inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to pilot a new process being introduced by CQC which looks at the overall quality of the service. This inspection was part of a pilot where we tested all the key lines of enquiry within our current inspection methodology.

The inspection visit was unannounced. At our previous inspection of April 2013 we found the service to be meeting the requirements of the Health and Social Care Act 2008

Cookridge Court and Grange is situated in the Cookridge area of Leeds. The service is registered to provide accommodation for up to 96 people who require personal care. The accommodation is situated over three floors that are serviced by passenger lifts. All bedrooms are single rooms with en-suite facilities. There are several communal and dining areas and the home has an enclosed garden area. At the time of our visit there were 89 people living at the service.

The registered manager had registered with the CQC in April 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. Prior to our visit we were made aware that the registered manager had resigned from their post and was working their notice period. On our arrival at the service we were told a decision had been taken for the manager to take leave rather than complete their notice period.

Before this visit we had received information of concern about the implementation of a new medicines system, management arrangements, staffing levels and morale. We used this information to inform our planning for this visit.

There were not enough staff to meet people’s needs in a timely way. People told us staffing levels impacted on the care they received and the time they received their medicines. On the day of our visit people did not have a morning drink as there were no staff available to them. People told us staffing levels were reduced at weekends.

People were not always protected against the risks associated with the unsafe use and management of medicines. Although the provider had taken steps to address concerns following a transfer to a new pharmacist, people were not always receiving their medicines at the correct time or in accordance with the prescriber’s instructions. Staff did not have protected time to administer medicines and often had to leave the medicines round to complete other tasks. This increased the risk of mistakes and lengthened the time of the medicines administration rounds.

The building was well designed and maintained. However, the call bell system had not been working properly which meant people were at risk of the system not registering their call if they tried to call for assistance. The provider brought in a maintenance company to repair the system and put risk assessments in place to ensure people were checked on a regular basis. The service was clean. We identified some poor practice around storage of equipment but this was addressed during our visit.

Risks to people’s health and well-being were identified and care plans put in place to help people manage these risks. However, we found care plans were not always followed. One example included a person who was not supported to use a falls monitor to help manage the risks around them falling.

Staff had not all received sufficient training and support to allow them to undertake their role. Some senior staff had not received training to administer medication; most staff had not had Mental Capacity Act (MCA) training. All staff told us they had not had supervision to support them in their role.

People were supported to maintain a balanced diet. People told us they were satisfied with the quality of food. However, we found the mealtime experience varied on different units.

People’s health needs were monitored and where necessary referrals were made for specialist health support.

People who used the service and their relatives told us staff were caring and they were treated with dignity. However, this was compromised as staff did not always have time to provide timely care interventions. Our observations showed that where time allowed there were positive relationships between staff and people who used the service. However, this was not consistent.

Information was gathered about people that allowed staff to better understand their individual wishes and preferences. This included consideration of end of life care.

People who used the service were not supported to engage in meaningful activity. Where activities were offered they did not take into account the differences in people’s gender or their individual choices.

The service had not followed the provider’s complaints policy and procedure. This meant complaints had not always been recognised or recorded to improve the quality of the service provided or to allow the provider to monitor issues at the service.

The service did not have satisfactory management arrangements in place. The lack of monitoring by the provider had led to a decline in the quality of the care provided that had been allowed to continue. This had led to low staff morale and a high staff turnover that further impacted on the quality of the support provided to people who used the service. Although a new regional support manager had started work at the service they had not been in post for long enough to start to have a sustainable impact on the service.

We found different 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 the report.

Inspection carried out on 29 April 2013

During a routine inspection

We observed staff treating people with respect, being polite and courteous. People who used the service and their families had contributed their opinions and preferences in relation to how care was delivered. One person told us, “Staff listen to me and I can do what I want when I want.”

People had detailed care plans relating to all aspects of their care needs. They contained a good level of information setting out exactly how each person should be supported that ensured their needs were met. We spoke with seven people who used the service and they told us they were happy with the care and treatment they received. One person told us, “They are very nice and friendly people; it is like a hotel, everything is alright.”

People who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises. The design and layout of the premises was suitable for carrying out the regulated activity.

We found that people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People who used the service we spoke with told us there were always enough staff to help them when they needed support.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided a good overview of the quality of the service’s provided.