A S Care

A S Care is a residential care home providing personal care to up to 25 people in one adapted building. The service provides support to older people with dementia, mental health concerns, physical disability, and sensory impairment. At the time of our inspection there were 19 people using the service.

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

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service had not been fully implemented to support this practice.

The principles of the Mental Capacity Act 2005 had not been fully implemented with regards to people’s medicine. Assessments to determine people’s capacity to make informed decisions about declining their medicine had not been undertaken. The best interest process had not been followed to evidence decisions made to administer some people’s medicines without their knowledge, disguised in food or drink.

Staff were employed in sufficient numbers to meet people’s care needs. However, staff in supportive roles, including housekeeping, laundry and catering were part time. In the absence of supportive staff, their work was undertaken by care staff.

At the previous inspection we identified deep cleaning was not being undertaken. The provider had taken steps to recruit staff for the purpose of deep cleaning and had advertised the position.

Environmental improvements were ongoing in relation to decoration and maintenance as identified by the provider within their action plan. The service had a large garden. However, this was not well maintained, which limited people’s potential enjoyment of the outside space.

Improvements to information contained within people’s care records with specific care needs related to diabetes and oxygen therapy had been implemented. This had been underpinned by targeted training for staff in oxygen therapy and care.

People told us they felt safe at the service. Potential risks related to people's care were assessed. Medicine systems were managed safely.

People told us they were satisfied with the meals provided people's dietary needs were met.

The frequency and complexity of audits had improved to enable shortfalls to be noted more quickly so as action could be taken to bring about improvement.

People told us they were happy with the care provided and that they were supported by staff who were kind and caring. People’s views and that of family members were regularly sought, which included information as to what action was being taken by the provider in response to their feedback.

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 26 June 2023) and there were breaches of regulation. At this inspection we found improvement had been made with regards to Fit and proper persons employed and Good governance and the provider was no longer in breach of these regulations. However, the provider remained in breach of the regulation Safeguarding service uses from abuse and improper treatment.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained requires improvement. This is based on the findings at this inspection.

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

Why we inspected

We carried out an unannounced focused inspection of this service on 22 and 23 May 2023. Breaches of legal requirements were found in Safeguarding service uses from abuse and improper treatment, Fit and proper persons employed, and Good governance.

The provider completed an action plan after the last inspection to show what they would do and by when to improve Safeguarding service users from abuse and improper treatment. We issued a Warning Notice in relation to Fit and proper persons employed. We varied the conditions of registration in relation to Good governance.

We undertook this focused inspection to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those breaches of regulation.

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 a continued breach in relation to Safeguarding service uses from abuse and improper treatment. The principles of the Mental Capacity Act for the administration of medicines being given without a person’s knowledge, hidden in food or drink, had not been implemented to ensure people’s care and treatment was lawful and in their best interests.

We have made a recommendation for the provider to review the hours provided by housekeeping, laundry and catering staff, to ensure the needs of the service are met without impacting on the role and responsibilities of care staff.

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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

A S Care is a residential care home providing personal care to up to 25 people in one adapted building. The service provides support to older people with dementia, mental health concerns, physical disability, and sensory impairment. At the time of our inspection there were 18 people using the service.

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

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Care plans did not always contain consistent and up to date information. Staff had not always been recruited safely. Infection control measures were not always satisfactory.

Improvements had been made at this service since our last inspection. However, there was ongoing concerns about the recording of diabetes and other treatments, which had not been identified by the provider’s own checks.

Some improvement had been made with medicines management aside from insulin, a medicine used to treat diabetes. Audits had not always been implemented effectively to drive improvements.

People reported they felt safe at A S Care. The premises decoration and upkeep was significantly improved this inspection. There were sufficient, suitably qualified staff. Meals were reported as being good quality, with a choice for people.

The registered manager was reported as being approachable, and was actively seeking to improve the service before, during and after our inspection. People and relatives were consulted at regular intervals by questionnaires and meetings. Health and social care professionals spoke positively about their interactions with the registered manager and staff.

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 2 March 2023) and there were breaches of regulation. 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 some improvements had been made and the provider was no longer in breach of some regulations. However, we found the provider remained in breach of other regulations.

This service has been in Special Measures since 18 October 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 9 August 2022. Breaches of legal requirements were found in safe care and treatment, premises and equipment, good governance, staffing and fit and proper persons employed. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

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

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

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

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 safe care and treatment, safeguarding people from improper treatment and abuse, good governance and fit and proper persons employed 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 from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

A S Care is a residential care home providing the regulated activity personal care to up to 25 people in one adapted building. The service provided support to older people with dementia, mental health concerns, physical disability and sensory impairment. At the time of our inspection there were 20 people using the service.

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

The environment was not always safe. The provider’s own systems and processes to review the environment had not identified all the concerns we found at inspection.

Medicines management was not always safe. Care plans were not always up to date and sometimes lacked detail. People’s communication needs were not always addressed. End of life care planning was not always thorough.

There were not always sufficient suitably trained and recruited staff working at A S Care.

Infection prevention and control measures were sometimes lacking.

People were not provided with person-centred activities. They were not asked for their feedback and were not included in care plan reviews routinely.

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 requires improvement (published 24 December 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 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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection. We also received concerns in relation to staffing and the environment. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only. We inspected and found there was a concern with person centred care, so we widened the scope of the inspection and included the key questions of Responsive.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed to Inadequate based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe, Responsive and Well-led sections of this full report.

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

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

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and treatment, safeguarding service users from harm, maintenance and upkeep of premises and equipment, good governance, staffing and fit and proper persons employed, at this inspection.

Please see some of the action we have told the provider to take at the end of this 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 appeals period has now ended for this, and we have issued the provider with conditions.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘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.

A S Care is a residential care home providing accommodation and personal care for up to 25 older people, including people living with dementia. At the time of our inspection, there were 16 people living at the service.

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

Action was required to protect people from abuse and avoidable harm. Staff required refresher training to ensure they fully understood their role and responsibilities.

Some people were living with dementia and experienced periods of heightened anxiety that impacted on their emotional and behavioural wellbeing. The provider had planned specific refresher training to support staff’s understanding and enhance their skills.

Incident management processes were not fully effective. Incidents had not been analysed for themes, patterns, and any learning to reduce reoccurrence.

Medicines management systems and processes had recently been improved by the provider However, further action was identified as required to ensure people received their medicines safely. The provider took immediate action and implemented further changes, including staff refresher training.

Infection prevention and control measures was impacted by the quality of some flooring and furnishings that were difficult to keep clean and hygienic and needed replacing. Best practice guidance was not fully adhered to.

Staffing levels were found not to be sufficient to meet people’s individual needs and safety. The provider took immediate action and increased staffing levels in the afternoon. Improvements to safe staff recruitment practice had recently been implemented.

Since the last inspection, there had been changes with the management of the service. At the time of the inspection, the current registered manager had stepped down from their position and was in the process of de-registering. An acting manager had been in post four weeks and was in the position of submitting their registered manager application.

The provider’s systems and processes used to assess, monitor and mitigate risks were not fully effective in developing and driving improvements. The acting manager had developed an action plan and showed a commitment to make the required improvements. The provider acknowledged they needed to improve their oversight and had appointed a new compliance manager to assist them.

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

Rating at last inspection

The last rating for this service was Good (published 24 February 2018).

Why we inspected

We received anonymous safeguarding and moving and handling concerns. As a result, we undertook a focused inspection to review the key questions of Safe and Well-led only.

We found some evidence during this inspection that staff required refresher training in how to protect people from the risk of abuse and avoidable harm. We found no concern how people were supported in relation to moving and handling.

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

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

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

Please see the Safe and Well-led sections of this full report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care 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 how people were protected from avoidable harm and abuse, and the systems and processes used to monitor quality and safety.

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.

We found the following examples of good practice.

¿The service was clean. Regular and thorough cleaning took place throughout the service including touchpoint areas.

¿Procedures were in place to facilitate contact between people and their families. At the time of inspection, the service had people isolating with COVID-19, and therefore were not allowing routine visiting. Prior to this, people had been able to safely visit relatives.

¿Processes in place for any visitors were clear, and included a temperature check, hand sanitizing station, and appropriate PPE offered for use.

¿Suitable arrangements were in place to ensure that anyone moving in to the service, did so safely. This included a negative Covid 19 test before moving in, and isolating within the service.

¿Staff had access to sufficient supplies of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser. The registered manager had been proactive in ensuring stock levels remained good for the staff. We observed staff using PPE correctly throughout the service.

¿Staff followed guidelines with the donning and doffing of PPE, and had an area within the service where this could be done safely.

¿Regular testing was completed for staff and people living at the service. This meant prompt action could be taken should anyone test positive for COVID-19.

¿Regular checks and audits around infection control were completed to ensure the registered manager had oversight on the service, and could address any issues promptly if found.

A S Care 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.

A S Care accommodates up to 25 older people, some of whom have a mental health condition and some who are living with dementia. At the time of the inspection 22 people were using the service.

The overall rating for the service at our last inspection was Requires Improvement. The service has improved its rating from Requires Improvement to Good in the key questions ‘Is the service effective?’ And ‘Is the service well-led?’ The overall rating of A S Care has improved to Good.

People using the service told us they were safe and that they did not experience bullying. Staff had received training on how to identify potential abuse and know how to alert the appropriate person or external authorities should they have any concerns. To promote people’s safety, potential risks to people had been assessed and measures put into place to reduce risk that were understood and adopted by staff. Information to support people safely with ongoing health related conditions was documented. We found there were sufficient staff who had undergone a robust recruit process. Staff receiving ongoing training and support to ensure they continued to meet people’s needs safely. People were supported to take their medicine by staff and medicines systems were robust..

People’s needs were assessed and regularly reviewed to ensure people received effective care. Staff encouraged and supported people to eat a healthy diet. People's dietary requirements along with their likes and dislikes with regards to food and drink were recorded within their records. People were supported to access a range of health care professionals and staff worked in partnership with external agencies to ensure and promote people’s well-being.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The staff team supported people to make decisions about their day to day care and support. They were aware of the Mental Capacity Act (MCA) 2005 in ensuring people's human rights were protected. Where people lacked the capacity to make their own decisions, we saw decisions had been made for them in their best interest.

People using the service and their family members spoke positively about the caring approach of staff. They said staff were considerate of their needs and provided the care and support they needed. People and their family members told us their privacy and dignity was maintained by staff. We found staff interactions with people to be positive and supportive and saw positive examples of staff supporting people when they became anxious or distressed.

People had care plans which recorded the help and support they needed. People and family members in the main were aware of their care plans and where they were located. People and family members spoke positively about the individualised support they received. They told us their independence and choice was recognised and promoted. In some instances assistive technology and equipment was used to support people’s independence.

People and family members had raised with the provider and registered manager their wish to have greater access to activities both within A S Care and the wider community. The registered manager told us activities did take place, as confirmed by people we spoke with. An activity organiser encouraged people to take part in activities; however there was no dedicated budget and therefore the registered manager was reliant on fund raising to fund both activities and any equipment.

The open and inclusive approach adopted by the registered manager and staff meant people using the service and family members were confident that they could raise any concern they had. The registered manager had investigated concerns that had been made. Any information gathered following complaint investigations was used to improve the service provided and discussed at staff meetings.

The quality assurance manager and registered manager undertook a range of audits to ascertain the quality of the service. The registered manager took action where shortfalls were identified. We found that whilst a range of audits were carried out, including those carried out by external organisations, these were not collated into a single document and discussed with the provider at the governance meetings. This is an area of improvement needed to ensure all actions are planned for and reviewed.

People using the service and family members spoke positively of the registered manager and staff. People’s views and that of family members were sought, however many were not aware of resident meetings being held. Staff spoke positively of the support provided by the registered manager, on a day to day basis, and through meetings and monitoring of their competency to perform their duties.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care on our website at www.cqc.org.uk

The service A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 22 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

This inspection took place on the 18 July 2017 and was unannounced.

A S Care 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.

When people needed assistance this was provided promptly and we saw there was a visible presence of staff in communal areas to promote people’s safety. Staff told us the increase in the number of staff on duty had enabled them to provide improved care and spend time with people, talking with them.

Medicine was safely managed in the service and records showed that the systems for medicine management were robust. Staff provided people with assistance where it was needed to take their medicine.

Where people were at risk, staff had the information they needed to help keep them safe. This included clear guidance within people’s care plans as to how staff were to meet the needs of people’s health conditions; and respond appropriately should they have any concerns about a person.

The service has a registered manager. However the registered person informed us that they were now working at another service, within the same organisation and therefore the registered manager will need to submit an application to CQC to cancel their registration for A S Care. The provider had appointed a new manager who had been in post for three months at the time of the inspection, they informed us they would be submitting an application to CQC to be registered as the manager for A S Care. 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 carried out an unannounced comprehensive inspection of this service on 23 and 24 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We carried out a focused inspection of this service on 15 December 2016 to check that they had followed their action plan and to confirm whether they met the legal requirements. We found the provider had not met the legal requirements. The provider submitted a revised action plan. The Care Quality Commission took enforcement action and the service was placed into special measures. We did this as the service had been rated as 'Inadequate' in a key question over two consecutive inspections.

You can read the reports of the focused and comprehensive inspection, by selecting the 'all reports' link for A S Care on our website at www.cqc.org.uk.

We carried out an unannounced comprehensive inspection of this service on 6 February 2017. We undertook this inspection to check whether improvements had been made and to confirm whether the provider now met their legal requirements.

We found some improvements had been made in the management of people’s medicines. Some staff had undertaken training in the safe management of people’s medicines. Systems for checking people’s medicine administration had been put into place and this was part of the sharing of information between senior carers as part of the handover between staff shifts. However, we found instances when people had not been administered their medicine as per the prescriber’s instructions. This is an area for improvement to ensure people’s safety; health and welfare are promoted and maintained.

We found there were insufficient staff to promote people’s safety and respond to their needs. People who required assistance experienced delays in receiving care and support from staff as staff were supporting other people. This had an impact on the safety of people using the service and meant people needs were not met in a timely manner. Insufficient staff also meant there was limited opportunity for people to be encouraged or involved in activities within the service. This is an area for improvement to ensure people’s needs are met in a timely and effective manner to maintain their safety, health and welfare. We spoke with the provider and manager, who had themselves, identified staffing levels needed to be improved, and they confirmed action would be taken.

People’s individual risks had been assessed with care plans having been put into place to minimise risk, these included clear information and guidance for staff to follow to promote people’s safety, health and well-being. Records showed staff were following the information contained within people’s care plans and staff we spoke with were aware of the needs of people at the service. People’s health care needs were recorded within their care plans and records showed people accessed a range of health care professionals depending upon their needs.

We found improvements had been made in the induction of new staff and the training opportunities available to staff, however further improvements were needed. Discussions with staff and the training matrix we looked at confirmed staff had undertaken training; however training was still to be attended by some staff, which included training in dementia awareness. We observed an inconsistent approach of staff when supporting people living with dementia and those who had limited or no communication, which supported the need for staff training. The supervision of staff had been introduced and staff and records confirmed support to also be available through staff meetings.

Discussions with people using the service, their family members and records we viewed showed a greater understanding and awareness of people’s rights and choices, which included working within the legal framework of the Mental Capacity Act 2005. People’s views had been sought and where people were unable to make an informed decision then decisions had been made in their best interests and with the involvement of relevant professionals and family members.

We found improvements had been made to the meals provided by the service, however further improvements were needed to improve people’s dining experience. People using the service had been asked for their views about the food and menus had been updated to reflect people’s comments. Meals were now made on site, using fresh ingredients. The appropriate level of support people required from staff to eat their meal was not consistent, which may be attributed to insufficient staffing levels and staff awareness. People raised concerns as to the temperature of food and drinks when they were served. We spoke with the provider who confirmed they were in the process of talking with companies as to the cost of purchasing a trolley to keep food hot.

People using the service and their family members spoke positively about the caring approach of staff. They said staff were considerate of people’s needs and provided the care and support they needed. Family members informed us that their relatives’ care plans had been shared with them. People and their family members told us their privacy and dignity was maintained by staff. We found staff interactions with people in the main were positive and saw examples of staff supporting people when they became anxious or distressed. We did note occasions when staff could have been more responsive in identifying people’s needs, this lack of insight could be addressed by the provision of further training for staff in dementia awareness and additional staff being available to provide sufficient time for staff to provide the support people need.

The registered person and manager since the previous inspection had brought about improvements to the service, which was in part due to the increased oversight of the registered person. The registered person, quality assurance manager and manager regularly met to review the improvements made at the service and to plan further developments. The manager shared with us some of the further improvements planned, which focused on the environment and the provision of equipment to support those living with dementia. The manager carried out a range of audits and the findings of these were shared with the registered person for action.

We found two breaches 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.

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.

We carried out an unannounced comprehensive inspection of this service on 23 and 24 August 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused comprehensive inspection to check that they had followed their action plan and to confirm that they now meet legal requirements. This report covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for A S Care on our website at www.cqc.org.uk.

The provider submitted an action plan following the inspection of August 2016 advising us of the action they would take to address the breaches of regulations identified by the inspection of 23 and 24 August 2016.

A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 23 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

The registered manager at the time of our inspection was on planned extended leave. The provider had appointed a person to manage for A S Care who had been in post for a month at the time of the inspection.

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

We found provider had not made the required improvements. The provider had employed a quality assurance manager whose role was to monitor the quality of the service. The provider was unable to provide written documentation to support the outcome of the visits undertaken by the quality assurance manager. We found there to be no formal agreement as to the providers and quality assurance managers’ responsibilities and role in the governance of the service and the sharing of information or how the information would be used.

We requested the provider forward to us the quality assurance managers’ report and action plan, the business plan for A S Care and the minutes of the most recent staff meeting as these were not available on the day of the inspection. The information we requested was not provided.

The manager had undertaken audits in some areas of the service, however there was no formal system as to how this information was shared or monitored by the provider in order to drive improvements.

Staff had undertaken training since the previous inspection and further training had been organised. The manager had commenced a programme of formally supervising staff.

Environmental improvements had been made, which included the decoration of some bedrooms following an audit undertaken by the manager. A reminiscence room had been established to provide an area for people living with dementia to spend time.

A S Care provides residential care for up to 25 people many of whom are living with dementia. At the time of our inspection there were 22 people in residence. Accommodation is provided over three floors with access via a stairwell or passenger lift. Communal living areas are located on the ground floor. The service provides both single and shared bedrooms, with some having en-suite facilities.

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

The registered manager at the time of our inspection was on planned extended leave and the deputy manager was on planned leave. The provider arranged for a manager of another service they owned to facilitate the inspection.

The provider did not have in place systems or processes to assess the quality and safety of the service being provided and therefore had not identified that improvements were needed. The leadership and management of the service were not effective. This directly impacted on the quality of support and care people received and meant they did not experience the best possible health and quality of life outcomes.

People’s opportunities to influence the development of the service were sought. We found no evidence that where comments were received, these had been acted upon by the provider. The provider and staff did not actively promote an open and inclusive environment for people, especially with regards to those living with dementia. People living with dementia were not supported by staff that had a good understanding of their needs and people’s care plans and records reflected this. Information written as to the care people required or received did not show an awareness on the part of staff as to people’s individual needs and how dementia affected people in all aspects of their day to day lives.

People did not receive person centred care; there were institutional approaches and practices to care being observed and documented, which meant people did not receive individualised care or care as detailed within their care plan. Our observations and the contents of records evidenced a lack of understanding as to the rights of people and demonstrated a lack of respect afforded to those living with dementia as their views were not listened to or acted upon.

Poor record keeping and communication contributed to staff not being effective in providing appropriate care and support, which included information shared amongst the staff team as to the needs of people as well as inconsistencies in the training, supervision and appraisal of staff.

People’s safety could not be assured as records were not always accurate and information staff had access to promote people’s safety, which included risk assessment and care plans did not contain sufficient or consistent information. Records that were to be accessed in an emergency were not always up to date having the potential to impact on people’s safety and welfare.

People’s records evidenced that the needs of some had been monitored, with appropriate referrals being made to health care professionals. Records reflected people’s care plans were in some instances followed and measures taken where concerns had been identified by staff. However, this practice was not consistent to protect and promote everyone who used the service.

Systems for the management of people’s medicine were not robust, which had the potential to put people’s health and welfare at risk. A procedure for the administration of people’s medicine was not in place. We found medicine administration records were not completed in full and there were no instructions for staff to follow when administering medicine that was prescribed to be taken as and when needed, which had the potential for people not to receive their medicines consistently.

The internal and external environment whilst maintained did not take into account the needs of people living with dementia and there were no plans to develop the service reflective of current good practice or guidance.

People’s nutritional needs were met, however the dining experience of people was not optimised and people’s involvement in decisions about their meals were not sought.

The approach and attitude of staff towards people was not consistent in promoting people’s quality of life. We observed examples of staff working with people well, providing reassurance when they were distressed and encouraging them to take part in daily activities. However the opportunities for people to take part in the day to day living activity were very limited. Whilst some people did spent time in the garden a majority of people sat with their eyes shut in an armchair within one of the communal rooms.

People who used the service and visiting relatives spoke positively about the care provided and relatives told us they had made a decision to access the services of A S Care as they had confidence in the care their relative had received. Relatives told us they had been involved in the initial assessment of need and had met with the provider and manager who had welcomed them to the service.

We found five breaches 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.

We spoke with four people who used services, four staff on duty and a visitor. The visitor told us:"The home is always the same, and staff are always nice and friendly." One person said:" The staff are chatty and I am happy in my bedroom." We saw the activity coordinator promote people's welfare. They gave a manicure to one person and had organised a coffee afternoon with a group of people to sit together and talk in the afternoon. We heard staff singing with people, sitting and talking to them throughout our visit. Four people gave positive comments about the home except for one person who was unhappy with some aspects of the delivery of care. These concerns were raised with the manager during our visit for action. People said they were aware of how to raise concerns or to make a complaint. One person told us they had raised a complaint and this had not been recorded or acted on.

Other people told us,

'I like being here."

'I feel safe here and they always have music on. I like music'.