All inspections: The Island Residential Home

About the service

The Island Residential Home is a residential care home providing personal and nursing care to 29 people at the time of the inspection. People living upstairs were over 65 years old. Some people upstairs were cared for in bed. People living downstairs were mostly younger adults. The service can support up to 34 people.

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

People and relatives provided positive feedback about the service. They told us staff were kind and caring. Comments included, “Certainly know how to look after me"; “They have the skills to look after them”; “I can’t fault the carers”; “They are kind and caring” and “It’s a good place.”

Staff had been recruited safely to ensure they were suitable to work with people. People had regular staff who they knew well. People were well supported by competent, knowledgeable and well-trained staff. Staff were well supported by the management team.

The premises were clean and free from odours. We were assured that the provider’s infection prevention and control policy was up to date.

Risks to people’s safety had been well managed. Risks to the environment had been considered as well as risks associated with people's mobility and health needs. The provider continued to have systems in place to monitor accidents and incidents, learning lessons from these to reduce the risks of issues occurring again.

The design and layout of the service met people’s needs. Signposts were in place which helped people living with dementia.

Prior to people moving into the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person.

Meals and drinks were prepared to meet people's preferences and dietary needs. People told us they liked to the food.

The service was well-led. The management team carried out the appropriate checks to ensure that the quality of the service was continuously reviewed, improved and evolved to meet people’s changing needs. The management team promoted an open culture and were a visible presence in the service, staff felt listened to and valued.

People were protected from abuse and avoidable harm. People’s medicines were well managed.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly, they were referred to a fall’s clinic. Staff worked closely with the GP and other health professionals.

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 19 November 2019).

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 carried out an unannounced comprehensive inspection of this service on 17 and 18 September 2019. A breach of legal requirements was found. The provider completed an action plan after the last inspection to show what they would do and by when to improve good governance.

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.

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

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service 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 The Island Residential Home on our website at www.cqc.org.uk.

Follow up

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

About the service

The Island Residential Home is a residential care home that accommodates up to 35 people. People upstairs were over 65 and people living downstairs were younger adults. Some people were living with dementia. At the time of the inspection there were 31 people living at the service.

We found the following examples of good practice

Staff were observed wearing Personal Protective Equipment (PPE) when supporting people. Staff had access to PPE and there were ‘PPE stations’ around the service to ensure PPE was at hand when needed.

The registered manager provided people and staff information about COVID-19 in a variety of ways. This included easy to read guidance to help people understand the virus and support them to stay safe.

Cleaning schedules had been increased. Areas including light switches and door handles were cleaned regularly. A rolling programme of antiviral fogging had been introduced. Regular audits were used to the monitor cleanliness of the service.

Further information is in the detailed findings below.

About the service

The Island Residential Home is a residential care home providing personal and nursing care to 32 people at the time of the inspection. People living upstairs were over 65 years old. Some people upstairs were cared for in bed. People living downstairs were younger adults. The service can support up to 34 people.

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

Medicines records were not always accurate and complete. People were at risk of being given a medicine they were allergic to because allergy records in some care notes did not match the information within their medicines administration records. People’s confidential data around medicines was not always archived or disposed of securely.

People had received their medicines as prescribed and these medicines were available to them in a timely manner. Staff demonstrated a good understanding of medicines and the needs of the people at the service.

There were systems in place to check the quality of the service. However, the systems to review and check the quality of the service were not always robust, they had not identified the concerns we raised in relation to medicines management. This was an area for improvement.

Food and fluid records had improved since the last inspection, but some inconsistencies were found. One person’s records showed that fluid had been incorrectly added up, so the record showed that they had drunk more fluid than they had. There was no overall monitoring for this person as the target intake had not been completed. This is an area for improvement. People told us they liked the food at the service and were able to choose what they wanted to eat.

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. Improvements had been made to care records to show that mental capacity assessments had taken place in relation to specific decisions. Some improvement work was required as there were some assessments which contained conflicting information.

Risks to people’s safety had been suitably assessed and managed, this was a clear improvement since the last inspection. Staff followed the risk assessments and guidance. One person’s risk assessment contained conflicting information. This is an area for improvement.

There continued to be enough staff to keep people safe. The manager was able to deploy more staff as and when people's needs changed. Staffing was arranged flexibly. Staff were recruited safely.

Prior to people moving in to the service their needs were assessed. These assessments were used to develop the person’s care plans and make the decisions about the staffing hours and skills needed to support the person. People were reassessed as their needs changed to ensure the care they received met their needs.

People felt safe living at The Island Residential Home. Staff had the knowledge and training to protect people from abuse and avoidable harm. People said, “It is a nice place; I like it here it’s a lovely home and all the staff are excellent”; “I like it, it feels like home to me, I just come and go as I like” and “Staff are really nice and friendly, always very helpful.”

The service had been maintained and was clean and fresh. Contractors were working in the service to replace fire doors and bathroom suites.

Improvements had been seen across the service since our last inspection. The provider, management team and staff had worked hard to make sure people received quality care and support.

People had choice over their care and support, dignity and privacy was respected by staff. People told us staff were kind and caring and treated them well.

People had access to a range of different activities throughout the week. People told us that they took part in these and that they were enjoyable. Activities were also provided for people who received their care and treatment in bed.

People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians. The service worked closely with the GP and other health care professionals who visited the service regularly.

The provider had developed systems to monitor accidents and incidents and learning lessons from these to reduce the risks of issues occurring again. Records evidenced where follow up action had been taken after the accident or incident.

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 04 April 2019) and there were five breaches of regulation. The provider had failed to operate effective quality monitoring systems. The provider had failed to effectively manage risks and medicines. The provider had failed to plan care and treatment to meet people’s needs and preferences. The provider had failed to operate effective recruitment procedures. The provider had also failed to notify CQC about important events that had occurred.

The provider completed an action plan after the last inspection to show what they would do and by when to improve, they provided updates to this action plan each month.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations 9, 12 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found that the provider was no longer in breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Improvements had been made to quality monitoring systems, However, further improvements were required because medicines records had not always been well managed. This was a continued breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This service has been in Special Measures since 04 April 2019. 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

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.

About the service:

The Island Residential Home accommodates up to 34 people. At the time of our inspection, 28 people lived at the service. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors.

Rating at last inspection:

The last inspection was carried out on 06 February 2018. The service was rated Requires Improvement.

Why we inspected:

This inspection was brought forward in response to incidents that had occurred in the service and concerns that had been raised about the safety and management of the service. At the time of the inspection we were aware of incidents being investigated by third parties.

People’s experience of using this service:

The provider did not have effective safeguarding systems in place to protect people from the risk of abuse. Some incidents of abuse had not been appropriately reported to the local authority or relevant persons. Risk assessments did not have all the information staff needed to keep people safe, because risk assessments had not been reviewed and amended as people’s needs changed. This meant staff did not have up to date information to keep people safe.

Staff had not always been recruited safely to ensure they were suitable to work with people. The provider had not carried out sufficient checks to explore staff members' employment history to ensure they were suitable to work around people who needed safeguarding from harm. There were enough staff to support people's needs. The provider did not have a system in place to assess if staffing levels met people’s needs. The provider had recognised this and had asked the manager to develop this tool.

Medicines were not always managed safely. Medicines were stored at safe temperatures in monitored clinical rooms and medicines fridges. However, one medicine fridge contained a urine sample which was stored alongside people’s medicines. This was unhygienic and there was a risk that medicines could become contaminated. Medicines had gone missing in the service. Some people’s care plans contained body maps for staff to record where medicine patches were applied. These were not always completed. This meant that staff could not be assured that the site of application was rotated to prevent irritation to people’s skin.

The service was clean and we saw staff used protective equipment such as gloves and aprons. The flooring in one area of the service was damaged which prevented this from being effectively cleaned. We reported this to the provider.

People were not protected from harm because the provider had not been analysing accidents and incidents to look at causes or trends. This meant lessons could not be learnt from these events to reduce the same thing happening to others.

People were supported to receive meals which met their dietary requirements. People told us they liked the home cooked food. Staff had good relationships with healthcare professionals to ensure that people saw them when required. When people had been unwell or their needs had changed referrals had been made to relevant health professionals. However, records evidenced that some referrals had not taken place in a timely manner. Records of healthcare professional visits were not always documented, and instructions left were not always actioned.

Capacity assessments were inconsistent and did not always follow the Mental Capacity Act 2005. Some assessments made were not decision specific. People with capacity to consent to decisions about their care had not always signed consent forms. We made a recommendation about this.

The layout of the building met people's needs. The service had dementia friendly signage to help people find their bedrooms, bathroom or toilet and the lounge.

Assessments of people's needs had taken place after people had moved to the service. This meant that there had been some incidences of inappropriate or failed admissions. The new management team confirmed that plans were in place to carry out a detailed assessment prior to admission.

Staff told us they had received supervision meetings with their line manager to support their development. Staff received training which was effective and gave them enough information to carry out their duties safely to enable them to meet people’s needs.

People were supported and treated with dignity and respect; and involved as partners in their care. We observed people being treated with kindness and respect by staff. Staff took time to talk with people and played games, which people enjoyed. People told us they felt that staff took time to chat with them and listened to them. People told us that the staff respected their privacy and dignity. We observed staff knocking on doors before entering rooms and closing the doors when they carried out personal care.

Some care plans were in place. These were not always relevant and up to date to detail how staff should meet people’s needs. For example, people’s epilepsy care plans did not detail what type of seizures each person had, and how long the seizures usually lasted. Staff were knowledgeable about people and their care and support needs. People had access to activities to meet their needs. Some people had some plans in place for their choices at the end of their life. Staff ensured people were supported at the end of their lives.

People knew how to complain and felt their complaints were taken seriously. The complaints policy was also available to people in a pictorial format. The complaints procedure was displayed in the service.

Records were not accurate, complete or contemporaneous. Many files and records were missing and could not be located at the service. Records of people’s care were poor. There had been no audits or checks of the service completed since our last inspection by the manager. The provider had found this out through instructing an external consultant to carry out a review and audit of the service. The provider had arranged for the operations manager to carry out a comprehensive audit of the service and develop an action plan. This was carried out before we inspected and a copy of the action plan was given to CQC. The provider advised that they would send a monthly report to CQC to update the actions outstanding by the last working day of each month.

The provider had not effectively monitored the service to ensure that managers in post were carrying out their roles effectively. This meant that the quality of the service had deteriorated. Many of the previous improvements had been undone. The provider told us that they had learnt lessons from this. They had implemented a new staffing structure and recruited a new manager who was due to start on the 04 February 2019. They had put support in place to ensure the new manager received effective support, supervision and assistance to improve the service.

The provider had not always notified CQC about important events. One person sustained a serious injury in 2018 which had not been reported. People were invited to regular ‘resident’s meetings’ where they were asked their opinions about the service. People’s feedback had not always been acted on. The provider was in the process of gaining feedback about the service. Questionnaires had been sent to people who used the service and their relatives.

More information is in the detailed findings below.

Enforcement:

We identified four breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014. We also identified one breach of the Care Quality Commission (Registration) Regulations 2009. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: Following the inspection, we requested an action plan and evidence of improvements made in the service. This was requested to help us decide what regulatory action we should take to ensure the safety of the service improves.

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

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

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

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

The inspection took place on 06 February 2018. The inspection was unannounced.

At the previous comprehensive inspection on 05 June 2017 the service was rated Requires improvement overall and inadequate in the safe domain. The provider had breached Regulations 11, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. The provider had failed to meet the requirements of the Mental Capacity Act 2005. The provider had failed to ensure that medicines were suitably stored, administered and recorded. The provider had failed to asses and mitigate risks to people's safety effectively. The provider had failed to operate effective systems and processes to monitor the quality of the service. The provider had not deployed sufficient numbers of staff to meet people's needs. We asked the provider to make improvements to meet Regulations 11 and 18 and we served the provider a warning notice and told them to meet Regulations 12 and 17 by 11 August 2017.

The provider sent us an action plan which stated they would meet Regulation 11 and 18 by 30 September 2017. The registered manager continued to send a monthly update to evidence what actions they were taking to monitor and improve the service.

We carried out a focused inspection on 29 August 2017 to check that the provider had met Regulations 12, 18 and 17. We found they had met the warning notice for Regulation 17 and the requirement action for Regulation 18. Many improvements had been made in relation to meeting Regulation 12, however further improvements were still required to ensure people’s topical medicines were administered as prescribed.

The Island Residential Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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 was not registered to provide nursing care. Any nursing care was provided by community nurses.

At the time of our inspection, 34 people lived at the service. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors.

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

At this inspection, people and their relatives told us they received safe, effective, caring, responsive care and that the service was well led.

At this inspection, we found that the registered persons had not met Regulations 11 and 18 as stated in their action plan. However, further improvements were required to meet Regulations 12 and 17. We found a new breach of Regulation 19.

The provider had not always followed effective recruitment procedures to check that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Further improvements were required to ensure quality monitoring systems were effective to enable the provider to assess, monitor and improve the quality and safety of the service.

People's care plans detailed most of their care and support needs. Care plans had been reviewed and updated regularly. Two people’s care plans did not give staff clear information on how to meet all of their support needs. We made a recommendation about this.

Risk assessments were in place to mitigate the risk of harm to most people and staff. These had been updated when people’s needs had changed. Risk assessments did not have all the information staff needed to keep people safe. One person was diagnosed with epilepsy. There was no care plan or risk assessment in place to detail to staff how they should meet this person’s needs and what the person’s seizures may look like and what action they should take if they had a seizure.

Improvements had been made to the management of medicines, but there remained some errors in recording controlled drugs. We made a recommendation about this.

Medicines were only administered to people by staff that had been trained to do so. Medicines were stored securely. Medicines administration records (MAR charts) had been accurately completed.

Appropriate numbers of staff had been deployed to meet people's needs. Staff had attended training relevant to people's needs and they had received effective supervision from the management team.

People had choices of food at each meal time which met their likes, needs and expectations.

People were encouraged to participate in meaningful activities, which were person centred and included community trips.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The registered manager had systems in place to track and monitor applications and authorisations.

Staff knew and understood how to protect people from abuse and harm and keep them safe.

People were supported and helped to maintain their health and to access health services when they needed them.

Maintenance of the premises had been routinely undertaken and records about it were complete. Fire safety tests had been carried out and fire equipment safety-checked.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time.

People and their relatives had opportunities to provide feedback about the service they received. Compliments had been received from relatives.

People and their relatives knew who to talk to if they were unhappy about the service. The complaints procedure was available around the service. Complaints had been effectively managed.

People and staff told us that the service was well run. Staff were positive about the support they received from the management team. They felt they could raise concerns and they would be listened to.

We found three 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.

The inspection was carried out on 29 August 2017. The inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 34 people. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors. There were 28 people living at the home on the day of our inspection.

The registered manager of the service had left. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The new manager assisted us during the inspection. They were in the process of applying to become the registered manager. The new manager is referred to as ‘the manager’ in our report.

At the last comprehensive inspection, the service was rated requires improvement overall and inadequate in the 'Safe' domain.

We carried out an unannounced comprehensive inspection of this service on 05 June 2017. Two continuous breaches of legal requirements were found in relation to Regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and two other breaches were found in relation to Regulation 11 and Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We served the provider warning notices in relation to Regulation 12 and Regulation 17 and asked them to meet the legal requirements by 11 August 2017.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulations 11 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider told us they would meet these two regulations by 30 September 2017.

We undertook this focused inspection to check that the provider had met the warning notices. We checked to see if the service was safe and well led. This report only 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 The Island Residential Home on our website at www.cqc.org.uk.

At this inspection, we received positive feedback from people and staff.

Medicines practice had improved. However further improvements were required to ensure that topical medicines were appropriately administered and recorded. Protocols were not in place for all ‘as and when required’ medicines. Medicines were stored effectively in a temperature controlled environment. This evidenced the provider had complied with their warning notice, however topical records needed to be improved.

Risks to people’s safety and welfare had been managed to make sure they were protected from harm. Risk assessments had been reviewed and updated when people’s needs changed. People with diabetes were appropriately supported by staff to monitor their blood sugar levels and relevant action was taken when people’s blood sugar levels were high. This evidenced the provider had complied with their warning notice.

There were suitable numbers of staff deployed on shift to keep people safe. Effective recruitment procedures were in place to ensure that potential staff were of good character and had the skills and experience needed to carry out their roles before they were employed.

Systems to monitor the quality of the service were embedded. Audits picked up a number of issues and concerns which the management team had worked through. Audit tools were continuously updated to ensure that they captured the full picture of what was happening in the home. This evidenced the provider had complied with their warning notice.

The home was in the process of being decorated; the majority of the redecoration within the home had been completed. The home was clean and smelt fresh. Personal protective equipment was in place to protect people and staff from the dangers of cross infection.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.

Staff were positive about the support they received from the management team and the provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good.

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

We found 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 this report.

The inspection was carried out on 05 June 2017. The inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 34 people. Previously the provider had provided care and support for up to 38 people; they had made changes to their registration to reduce the numbers. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There was a passenger lift for access between floors. There were 31 people living at the home on the day of our inspection.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. The registered manager was not present during the inspection. The provider had employed a new manager; they were planning to apply to become the registered manager. The new manager is referred to as the manager in our report.

At our previous inspection on 29 November and 01 December 2016 we found breaches of Regulations 9, 11, 12, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires improvement’ overall and ‘inadequate’ in safe. As the provider had been rated inadequate in safe for two consecutive inspections, we placed the provider into special measures. We issued three warning notices in relation to Regulation 9, Regulation 12 and Regulation 17. We asked the provider to meet Regulation 9 and 17 by 17 February 2017. We asked the provider to meet Regulation 12 by 20 January 2017. We also asked the provider to take action in relation to Regulation 11 and Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We received an action plan on 14 February 2017 which stated that the provider planned to be compliant with Regulation 19 by 28 February 2017 and Regulation 11 by 10 March 2017. The provider had met a number of regulations as they had planned to. However, at this inspection we found two repeated breaches of Regulations and a new breach of Regulation.

At this inspection, we received positive feedback from people and their relatives. They told us that people received safe, effective, caring and responsive care.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights. However, care plans and documentation did not evidence that the MCA had been followed. MCA assessments contained conflicting information.

Medicines were not well managed. Medicines had not been recorded appropriately. There had been inconsistent monitoring of temperatures of areas where medicines were stored. Medicines had not always been given following the manufacturers guidelines.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm. Risk assessments had not always been reviewed and updated when people’s needs changed.

There were not always enough staff deployed on shift to keep people safe. At peak times such as meal times, more staff were required to keep people safe.

Systems to monitor the quality of the service were embedded. Audits picked up a number of issues and concerns which the management team had worked through. However, the audits had not picked up issues which were breaches of Regulations found during the inspection.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

The home was in the process of being decorated; the majority of the home had been completed. Signage around the home had improved to support people living with dementia. The home was clean and smelt fresh.

Improvements had been made to the training staff had received. Staff had received training relevant to their roles. Staff had received regular supervision.

People’s weights had been consistently monitored to ensure people remained in good health.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys.

People’s care plans had been reviewed and updated to ensure that their care and support needs were clear and their preferences were known. The management team were still working on reviewing and updating care plans to ensure they reflected the care people received from the service. People and their relatives had been involved with planning their own care.

People were encouraged to take part in activities that they enjoyed. People were supported to be as independent as possible.

Staff knew and understood how to protect people from abuse and harm and keep them safe. The home had a safeguarding policy in place which listed staff’s roles and responsibilities.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority and had been approved.

People had choices of food at each meal time. People were offered more food if they wanted it and people that did not want to eat what had been cooked were offered alternatives. People with specialist diets had been catered for.

People were supported and helped to maintain their health and to access health services when they needed them.

Staff were cheerful, kind and patient in their approach and had a good rapport with people. The atmosphere in the service was calm and relaxed. Staff treated people with dignity and respect.

People were supported to maintain their relationships with people who mattered to them. Relatives and visitors were welcomed at the service at any reasonable time and were complimentary about the care their family member’s received.

People and their relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the management team and the provider. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour. Handovers between staff going off shift and those coming on shift took place to make sure all staff were kept up to date.

The overall rating for this service continues to be ‘Requires improvement’. However, we are leaving the service in 'special measures'. We have done this because the service has been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services in special measures.

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

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

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.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection was carried out on 29 November and 01 December 2016. Our inspection was unannounced.

The Island Residential offers accommodation and long term care and support to up to 38 people. Some were older people living with dementia, some had mobility difficulties, sensory impairments and some were younger adults. Some people received their care in bed. Accommodation is arranged over two floors. There is a passenger lift for access between floors. There were 33 people living at the home on the day of our inspection.

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

At our previous inspection on 05 and 07 April 2016 we found breaches of Regulations 9, 12, 13, 17, 18 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as ‘Requires improvement’ overall and ‘inadequate’ in safe. We asked the provider to take action to meet the regulations.

We received an action plan on 06 July 2016 which stated that the provider had met some of the regulations already and planned to be compliant with the Regulations by 30 July 2016. However the provider had not met the regulations as they had planned to. At this inspection we found a number of repeated breaches of Regulations.

At this inspection we received positive feedback from people and their relatives. They told us the people received safe, effective, caring and responsive care.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

There were procedures in place and guidance was clear in relation to the Mental Capacity Act 2005 (MCA) that included steps that staff should take to comply with legal requirements. Staff had a good understanding of the MCA 2005 to enable them to protect people’s rights. Care plans and documentation did not evidence that the MCA had been followed.

People’s weights had not consistently monitored to ensure people remained in good health.

The home was in the process of being decorated, some bedrooms on the ground floor had already been completed. The majority of other bedrooms and communal areas in the home were yet to be started. These rooms were shabby and in need of repair. The flooring in a number of the bedrooms upstairs was rippled and uneven. We made a recommendation about this.

Some areas in the upstairs of the home smelt of stale urine. We made a recommendation about this. The rest of the home was clean and smelt fresh.

Topical medicines administered were not adequately recorded to ensure that people received them in a safe and effective manner. We made a recommendation about this.

Improvements had been made to the training staff had received. However not all staff had received training relevant to their roles. Some staff had not received regular supervision. We made a recommendation about this.

The decoration of the home did not follow good practice guidelines for supporting people who live with dementia. We made a recommendation about this.

People’s view and experiences were sought during meetings and through quality assurance surveys. Relatives were also encouraged to feedback through surveys. The provider had not always acted on feedback given in a timely manner. We made a recommendation about this.

People’s care plans were not complete and were not updated to ensure that their care and support needs were clear and their preferences were known.

Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Records were not always accurate and complete.