Ashview House Residential Care Home

Ashview House is a residential care home providing personal care for up to 22 people in one adapted building across two floors. At the time of the inspection, 19 people were living at the service some who were living with dementia.

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

There were systems in place to ensure there were enough staff to support people in a safe and effective way. Risks were assessed and managed to mitigate the risk of avoidable harm. Medicines were managed in a safe way and staff adhered to infection prevention and control principles to reduce the risk of the spread of infection. Lessons had been learned when things went wrong and there were notable improvements made since the last inspection.

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’s needs were assessed and planned for and staff were recruited safely and trained to ensure they knew how to support people in the most effective way. People had access to healthcare as required and health and social care professionals were consulted about people’s care needs where necessary, in a timely way. People’s nutritional needs, and dietary preferences were met.

The registered manager had made improvements since the last inspection and had created a positive atmosphere within the service where overall, staff told us they were happy to work. Relatives gave us positive feedback about Ashview House and the care their relatives received. Quality assurance systems were in place to assess and review the quality and safety of the service.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 23 June 2021) 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 improvements had been made and the provider was no longer 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.

We previously carried out an unannounced inspection of this service on 24 May 2021. Breaches of legal requirements were found. 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. 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 from requires improvement to good. 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 Ashview House Residential Home on our website at www.cqc.org.uk.

Follow up

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

Ashview House is a residential care home providing personal care for up to 22 people in one adapted building across two floors. At the time of the inspection, 21 people were living at the service.

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

People’s risks were not always assessed and planned for. Medicines were not always managed in a safe way.

The governance systems in place were not always effective which meant lessons were not always learned when things went wrong.

People did not always have their dietary requirements met and not all staff had sufficient knowledge to respond to people’s specific health needs, such as diabetes.

We have made a recommendation about reviewing people’s dependency levels to ensure there are enough staff to meet people’s needs.

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; however, the policies and systems in the service did not support this practice.

Staff understood how to keep people safe from the risk of harm and abuse and worked with other professionals to ensure people received on-going healthcare support.

There was a registered manager in place and staff told us they felt supported in their work.

People, staff and relatives spoke positively about the registered manager and felt they were committed to making improvements across the home.

Rating at last inspection

The last rating for this service was good (Report published 22 October 2019)

Why we inspected

We received concerns in relation to the management of medicines and people’s care needs. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective 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 Ashview House residential Home on our website at www.cqc.org.uk

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to Regulation 9 (Person centred care), Regulation 11 (Need for consent), Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) at this inspection.

We have issued the provider with a warning notice. We will check the provider is taking action to comply with the legal requirements set out in the warning notice.

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.

Ashview House is a residential care home providing accommodation and personal care for up to 22 people. The service is provided in one adapted building over two floors. At the time of the inspection 14 people were using the service and therefore, the second floor was not being utilised.

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

People were safeguarded from the risk of abuse and harm as staff understood how to recognise and report abuse. People’s risks were assessed, and plans were in place to help support staff to keep people safe. Medicine management had significantly improved, and people received their medicines on time and in a safe way.

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 received enough food to maintain a balanced diet and staff worked well with other agencies and organisations to ensure people’s health and social needs were met. Some parts of the building had been refurbished and there was an on-going improvement plan in place.

Staff were kind and caring and supported people in a way that respected privacy and dignity. Staff knew people well which meant they could provide care in line with people's wishes and preferences. People knew how to make a complaint about the service.

The registered manager had made changes and improvements since our last inspection and people, relatives and staff felt the home was managed well. There were systems in place to monitor and drive improvement.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 30 November 2018) and there were two 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 improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

As a result of previous enforcement action, a condition was placed on the provider's registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people's safety and remains in place. At this inspection, we identified further breaches of regulation.

Ashview House Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection ten people lived in the service however, two people were in hospital.

There were two registered managers at the home, however only the most recently registered manager was actively working in the home. The other registered manager, who was also a director in the business, also worked at another home and was spending their time at the other home. 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 and associated Regulations about how the service is run.

Systems in place were not always effective at identifying areas to improve on and timely action was not always taken to ensure concerns were resolved promptly. The registered manager did not always have sufficient time to be able to effectively complete their role. Information was not always accessible when it was required. Staff felt supported by the registered manager however there were some tensions between staff.

People’s medicines were not always safely managed. Prescription labels and guidance was not always being followed.

Staff did not always have enough time to support people effectively as they were expected to carry out additional duties in the kitchen. Generally, staff were recruited safely however improvements were needed to verifying employment history or new starters.

Risks were assessed and planned for but further improvement was needed to ensure plans were reviewed when necessary and being followed. Lessons were not always learned in a timely manner; however, some improvements were identified.

People were protected from avoidable harm by staff who understood their safeguarding responsibilities. The risk of infection control was minimised by the home being kept clean and staff wearing personal protective equipment when necessary.

There was mixed feedback about the food, however people were supported to have sufficient amounts to eat and drink that was appropriate for their dietary needs. People had their health conditions monitored when necessary and had access to other health professionals when required. We made a recommendation to ensure staff had their training updated at appropriate intervals.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. We have made a recommendation to avoid future delays of Deprivation of Liberty Safeguards (DoLS) applications.

The environment was clutter free and had some appropriate labelling, however was not always suitable for those with dementia and was in need of updating. Plans were in place for the improvement of the environment.

There was mixed feedback about activities however we saw steps were being taken to try and improve this for people. We have made a recommendation to ensure people have a personalised programme of activities available to partake in should they choose. Staff knew people well and relatives were involved in developing care plans. People and relatives felt able to complain and an appropriate policy was in place. No one required palliative care, however people’s end of life choices had been considered by the service.

People were supported by caring staff to help maintain their independence and their dignity. People could choose where to spend their time and visitors could attend at any time.

Ashview House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. This care home is registered to provide care to up to 22 people. At the time of the inspection six people were using the service, however two of these people were in hospital on the day of the inspection.

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

Although significant improvements to the quality of care had been made over a period of time, further improvements were required. The registered manager had put systems in place to monitor and improve the quality of service and some of these had been effective.

The registered manager had acted upon issues of concern and managed staff performance to ensure people received appropriate care.

The registered manager knew their requirements in relation to their registration with CQC and the provider was carrying out quality checks on the service.

People's medicines were not being consistently well managed and staffing levels had not been assessed as sufficient to meet people's needs and keep them safe.

Risks of harm to people were minimised and lessons were learned following incidents that had resulted in harm to people.

People were safeguarded from the risk of abuse as staff followed safeguarding procedures when they suspected abuse.

New staff were employed through safe recruitment procedures.

There were infection control procedures in place to prevent the spread of infection.

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.

As a result of previous enforcement action, a condition was placed on the provider's registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people's safety and remains in place.

At this inspection, we identified continued and new Regulatory breaches. The overall rating for this service remains 'Inadequate' and the service therefore remains in 'Special measures' whilst we continue our enforcement action.

Ashview Residential Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection six people were using the service.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

Systems were not always effective at identifying quality concerns. Medicines audits were taking place but they were not always finding issues that were present. Other audits were taking place such as environmental, kitchen and infection control audits which did not always identify issues. Timely action had not always been taken to resolve actions if they had been identified. These shortfalls posed a significant risk to the people living in the home.

Quality assurance records were not always up to date, such as the training matrix which had a member of staff missing from it, despite them receiving training months before our inspection.

Medicines were not managed safely. Stock levels did not always balance meaning we could not be sure whether people were always having the correct amount of their prescribed medicine. Some medicines were out of date, guidance for ‘as and when required’ medicines was not always been followed and recording of the administration of medicines was not always accurate.

People’s health care plans were not always followed which meant there was a risk to people’s long term health associated with their condition.

People with specific dietary requirements were not always supported in a way that met their needs.

Health conditions were not always effectively monitored. People were supported to access other health professionals however guidance from health professionals was not always followed.

Staff knew how to recognise potential abuse and how to report it. Staff felt more supported. However, other staff training was not effective as people were not always being supported appropriately.

A notifiable safety incident was not reported to us, which meant that we could not accurately monitor safety at the service.

Improvements were noted about the provider complying with the Mental Capacity Act 2005 (MCA) however further improvements were required to ensure people’s ability to make decisions and any decisions taken on a person’s behalf were clearly recorded.

An action plan was in place based on feedback from previous inspections and from feedback from an external consultant who was working with the home. We found some improvements had been made but some of the actions were still on-going or were not fully embedded, so continued improvements were required.

People and relatives felt there were enough staff so people did not have to wait for support. Recruitment of staff had improved although further improvement were required.

The home was generally clean and infection control measures were in place.

People and relatives felt staff were caring and that they were treated with respect. People were encouraged to be independent where possible.

Relatives felt able to complain. Complaints were being recorded, although the outcome was not always available. The complaints policy was not up to date and had missing information.

The home environment was tidy however some décor needed updating to ensure it was suitable for people with dementia. Future plans were in place to make improvements to the home.

People and relatives were involved in developing their plans of care and staff had the opportunity to read these plans.

People had the opportunity to partake in activities and leave the home on trips.

The provider had considered people’s end of life choices and plans had been put in place with basic information.

There was an Equality Policy in place, which took account of the protected characteristics such as gender, sexuality, race, and religion, for example. The provider and manager were able to provide us examples where they had been supportive of some of the protected characteristics.

People, relatives and staff were complimentary of the acting manager.

The provider was continuing to display their inspection rating as required.

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.

As a result of previous enforcement action, a condition was placed on the provider’s registration with us that prevented them from admitting and re-admitting people to the service without our authorisation. This condition was made to promote people’s safety and remains in place. This condition has been breached by the provider since our last inspection and we are taking action to address this.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection nine people were using the service. However, one of these people was in hospital as a result of a safety incident that had occurred at the service.

There was a registered manager at the home. 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 and associated Regulations about how the service is run.

At this inspection, we identified a number of continued and new Regulatory breaches. The overall rating for this service remains ‘Inadequate’ and the service therefore remains in ‘Special measures’ whilst we continue our enforcement action.

We found that the provider continued to have ineffective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

A notifiable safety incident had not been reported to us, which meant that we could not accurately monitor safety at the service.

Risks to people’s health, safety and wellbeing were still not always assessed, planned for, managed and reviewed to promote people’s safety.

Safe recruitment systems were still not in place to ensure staff were of suitable character to work with the people who used the service.

Safety incidents were not always analysed and responded to effectively and promptly, which meant the risk of further incidents was not always reduced.

Medicines were not always managed safely.

Some people told us they still experienced occasional delays in receiving the care and support they required. Staffing levels were not consistently reviewed to ensure safe staffing levels were maintained.

We were still not assured that people’s health needs were consistently monitored and advice from health care professionals was not always followed to promote people’s health, safety and wellbeing.

Accurate records were not maintained to show staff had received the training they needed to meet people’s needs and keep people safe. Staff reported that they had not received all the training they required.

An effective complaints system was not in place to ensure complaints were recorded and managed appropriately and promptly.

Deprivation of Liberty Safeguards (DoLS) requests were made when restrictions were placed on people. However, these were not always completed in line with the Mental Capacity Act 2005 (MCA). People’s capacity to consent to their care was not regularly assessed and reviewed in line with the MCA.

Some improvements had been made in relation to people’s receiving care that met their individual care preferences. However, further improvements were needed to ensure people could access activities that were meaningful and therapeutic to them.

Although people were involved in the initial planning of their care, they were not involved in regular reviews of their care to ensure their care preferences had not changed. This meant people were at risk of receiving care that did not meet their changing preferences.

People could choose the foods they ate, but detailed information about people’s specialist dietary needs was not always readily accessible to ensure consistent care.

Some people spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people were not consistently treated in a dignified manner.

People were supported to make day to day choices about their care and the choices people made were respected. People’s right to privacy was promoted.

Staff knew how to identify and report incidents of potential abuse and neglect.

The provider was now displaying their inspection rating on line as required.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service may have a physical disability and/or mental health needs, such as dementia. At the time of our inspection 11 people were using the service.

There was a registered manager at the home. 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 and associated Regulations about how the service is run. A home manager had also been recently recruited and the registered manager told us they also planned on registering with us.

At this inspection, we identified a number of Regulatory Breaches. The overall rating for this service is ‘Inadequate’ and the service has therefore been placed into ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

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

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

At this inspection, we found that the provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the registered manager or provider.

Recent changes in management had led to people and staff feeling unsettled.

Risks to people’s health, safety and wellbeing were not consistently identified, managed and reviewed and people did not always receive their planned care.

People were not always protected from the risk of abuse because some staff were not trained in how to recognise and report abuse. Suspected abuse was not always reported as required. Safe recruitment systems were not in place to ensure staff were of suitable character to work with the people who used the service.

Safety incidents were not always analysed and responded to effectively, which meant the risk of further incidents was not always reduced.

There were not always enough suitably skilled staff available to keep people safe and meet people’s individual care needs.

People told us they enjoyed the food. However, we found that some people did not always receive the support they needed to eat. Mealtimes were not a pleasant experience for everyone as they were lengthy and people couldn’t always choose where they dined.

The requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) were not always followed to ensure people were supported to consent to their care. We identified one person who was potentially being unlawfully deprived of their liberty.

We were not assured that people’s health needs were consistently monitored and advice from health care professionals was not always followed to promote people’s health, safety and wellbeing.

Some people spoke fondly about the staff and at times, we observed some positive interactions between staff and people. However, we found that people were not consistently treated in a caring manner. Dignity was not always promoted.

Some people were offered regular choices about their care. However, improvements were needed to ensure all people were offered daily choices about the parts of their care they could make decisions about. Improvements were also needed to ensure staff respected the choices people made.

People were not consistently involved in the planning and review of their care. This meant people’s care records did not contain up to date information about their care preferences. We found that people did not always receive care in line with their individual preferences.

Most people told us they knew how to complain. However, we found concerns or complaints about care were not always raised or responded to promptly.

The inspection rating was not being displayed on the provider’s website as required by law.

People’s right to privacy was promoted. People received their medicines as prescribed.

There was a programme of social and leisure based activities on offer to people that reflected their activity preferences.

We previously inspected this service on 25 January 2016 and 1 December 2015 where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. This service was placed into special measures as a result of an earlier inspection in April 2015 and it had remained in special measures until this inspection. Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, 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. At this inspection we found that the improvements the provider and registered manager had made were enough for us to remove the service from being under special measures.

At this inspection three people were using the service. The numbers of people using the service were low because of the action taken by us (CQC) and the local authority after our previous inspections, to safeguard people from risks to their health, safety and well-being. Following our December 2015 inspection, where we identified concerns for people’s safety and wellbeing, we placed a condition on the provider’s registration preventing them from admitting new people to the service. In March 2016 we agreed that the provider could begin to admit people to the service. The service can therefore now provide accommodation and personal care for up to 15 people.

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 and associated Regulations about how the service is run.

Although we identified some improvements had been made, further improvements were required to ensure people consistently receive care that is safe, effective, responsive and well-led.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not always followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This was a continued breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Improvements were needed to ensure risks to people’s health, safety and wellbeing were consistently and promptly assessed, monitored, managed and reviewed.

Gaps in the staffs’ knowledge and skills needed to be addressed and maintained to ensure people receive care that is safe and meets their needs.

Improvements were needed to ensure people’s care preferences were thoroughly assessed, recorded, monitored and met.

A manager or senior member of staff was not always available to lead shifts and coordinate people’s care. When concerns with the quality of care were identified, appropriate action to sustain improvements in quality were not always effective.

People’s medicines were managed safely and people’s health needs were monitored and prompt advice from health and social care professionals was requested when people’s needs changed.

Staff understood how to protect people from the risk of abuse and there were sufficient numbers of staff to meet people’s needs.

People could eat and drink suitable amounts of food and drink that met their individual preferences.

Staff treated people with kindness and compassion and people’s privacy was promoted. People were encouraged to make choices about their care and independence was promoted.

People were enabled to participate in activities that were meaningful to them. This included activities at the home and in the community.

People knew how to make a complaint and the complaints policy was readily accessible to people and visitors. People’s feedback about the care was sought through regular meetings.

Our last inspection took place on 1 December 2015, where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. This service was placed into special measures as a result of an earlier inspection in April 2015. After our December inspection, we found there was not enough improvement to take the service out of special measures and we continued to take enforcement action against the provider. This included preventing the provider from accepting new admissions to the service. Following this inspection, we found that although some improvements had been made, these were not sufficient enough to remove the service out of special measures. CQC is now considering the appropriate regulatory response to resolve the on-going problems we found.

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection three people were using the service. The numbers of people using the service were low because of the action taken by the local authority after our last inspection, to safeguard people from risks to their health, safety and well-being.

The service had a registered manager. However, they were no longer working at the home. 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 and associated Regulations about how the service is run. A new manager had been appointed by the provider and they had applied to register with us. At the time of our inspection, their application was being considered by us.

During this inspection we found that some of the required improvements had not been made and we identified a number of continued and one new breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009.

Risks to people’s health and wellbeing were not consistently assessed, managed and reviewed. This meant systems were not always in place to promote people’s health, safety and wellbeing.

The provider did not have effective systems in place to consistently assess, monitor and improve quality and manage risks to people’s health, safety and wellbeing. This meant that concerns with people’s care, including safety concerns were not always being identified and rectified by the provider.

People’s health needs were not consistently monitored and prompt advice from health and social care professionals was not always requested when people’s needs changed.

When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not always followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

Effective systems were not in place to ensure everyone who used the service could safely access the community if they chose to do so.

Improvements had been made to the way medicines were managed. This meant people were protected from the risks associated with medicines. Staff understood how to protect people from the risk of abuse.

There were sufficient numbers of staff to meet people’s needs. Staff had started to receive the training they required to provide them with the knowledge and skills to meet people’s needs effectively.

People could eat and drink suitable amounts of food and drink that met their individual preferences.

Staff treated people with kindness and compassion and people’s privacy was promoted. People were encouraged to make choices about their care and independence was promoted.

The new manager had sought feedback from people who used and visited the service. They planned to use this feedback to identify what improvements were needed to improve people’s care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

Staff felt supported by the new manager and staff spoke positively about some of the improvements they had made to people’s care.

Our last inspection took place in April 2015, where we identified multiple Regulatory breaches. We found the service was not safe, effective, caring, responsive or well-led. As a result of our last inspection, this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found

The service is registered to provide accommodation and personal care for up to 22 people. People who use the service have physical health and/or mental health needs, such as dementia. At the time of our inspection 16 people were using the service. Two of these people were using the service for an agreed short period of time. This is called respite care.

The service had a registered manager. However, they were no longer working at the home. 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 and associated Regulations about how the service is run. An acting manager had been appointed by the provider and they had begun the process of registering with us.

During this inspection we found the required improvements had not been made and we identified a number of continued and new breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. We are therefore continuing to take enforcement action against the provider.

There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual care needs and preferences were not always met.

Risks to people’s health and wellbeing were not consistently assessed, managed and reviewed and people did not always receive their planned care. People were also not always protected from potential abuse. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.

Medicines were not managed safely which meant people did not always receive their medicines as prescribed.

People were not always supported to eat in accordance with their agreed care. This meant people’s risk of malnutrition was not always being managed effectively.

When people were unable to make important decisions about their health and wellbeing, the provider did not always act in accordance with the law.

People’s health needs were not consistently monitored and prompt advice from health and social care professionals was not requested when people’s needs changed.

There were gaps in the staffs’ knowledge and skills that meant some people’s specialist needs were not met safely or effectively.

The provider did not have effective systems in place to assess, monitor and improve quality and manage risks to people’s health and wellbeing. This meant that poor and unsafe care was not being identified and rectified by the provider. The provider could not demonstrate that feedback from people and the staff was used to improve the quality of care. People were reluctant to complain about the quality of care.

The provider did not always inform us of incidents that occurred at the service and pre-inspection information was not completed accurately. This meant we were not always aware of reportable incidents that had occurred within the home.

People were not always treated in a caring manner by the staff and people’s privacy and dignity was not consistently promoted. People were not always able to make choices about their care.

Some improvements had been made in the recording of people’s care preferences and activity provision. However, further improvements were needed to ensure people’s individual preferences and needs were regularly reviewed and met.