Archived: Coundon Manor Care Home

Coundon Manor is a care home and is registered to provide personal and nursing care for up to 74 older people including people living with dementia, physical disabilities and sensory impairments. At the time of our inspection 44 people lived at the home.

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

The management of risks associated with people’s care and support had improved. Staff followed the individual instructions in risk assessments and care records to ensure safe care was provided in line with people’s assessed needs. Further action was planned to ensure accurate records of the care and support provided to people were maintained. People felt safe living at Coundon Manor. Improvements had been made to ensure people’s medicines were stored, administered and disposed of in line with the providers procedure and best practice guidance.

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 21 October 2022) and there were breaches of regulation in relation to safety and governance of the service. We served a Warning Notice in relation to Safe care and treatment. At this inspection we found improvements had been made in this area and the provider is now meeting that regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 (Safe Care and Treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

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 use targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Coundon Manor 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.

Coundon Manor is a care home and is registered to provide personal and nursing care for up to 74 older people. At the time of our inspection 43 people lived at the home and one person was in hospital. Accommodation is provided in a purpose-built home across two floors. One floor provides specialist care to people who live with dementia.

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

Risks associated with people’s care were not consistently assessed and well managed. Medicines were not always managed safely and in line with the providers policy. Despite these shortfalls, people felt safe living at Coundon Manor. Staff were recruited safely, and enough staff were on duty to meet people’s needs and provide safe care.

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 provided positive feedback about the food and staff knew what people liked to eat and drink and understood people’s dietary requirements.

Quality assurance checks were not always effective and robust enough to provide effective oversight of the service. As they had failed to identify the issues we found, such as gaps in the call bell audits.

A service improvement plan was under constant review, while the provider had addressed some of the concerns raised at our last inspection. Further improvement was required, to ensure people consistently received safe care and support. New systems and processes introduced also needed time to fully embed to ensure they were sustained.

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 20 July 2022) and there were breaches of regulation. The provider had received a warning notice following the last inspection and they had to be compliant with this. The provider was also required to send us an action plan telling us how they would improve and by when. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

The overall rating for the service has remained requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

We undertook this focused inspection to follow up on action we told the provider to take at the last inspection. 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.

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

We have found evidence that the provider needs to make improvements. Please see the safe, 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 Coundon Manor on our website at www.cqc.org.uk.

Enforcement and Recommendations

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

We have identified breaches in relation to people’s safety and the governance of the service. We found the provider failed to meet the warning notice we issued at the last inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

Coundon Manor is a care home and is registered to provide personal and nursing care for up to 74 older people including people living with dementia physical disabilities and sensory impairments. At the time of our inspection 53 people lived at the home and one person was in hospital.

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

The quality and safety of the service had deteriorated since our last inspection. The lack of provider oversight and instability within the management team meant previously demonstrated standards and regulatory compliance had not been maintained. The provider's systems and processes designed to identify shortfalls, and drive improvement were not always effective. Opportunities to learn lessons had been missed.

The limited availability of staff and lack of training completed by some staff negatively impacted on people’s safety and experiences of living at Coundon Manor. In addition, some staff training was not up to date. Action was planned to address this. Risks associated with people's care were not always assessed and well-managed. Some aspects of medicines management and the prevention and control of infection required improvement.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Improvement was needed to ensure people’s experiences at mealtimes were positive. Plans were in place to refurbish and develop the environment of the home to ensure it was a nice place for people to live.

Despite our findings people and their relatives felt the service was safe. Permanent staff were recruited safely, and staff understood their responsibilities to keep people safe. People had access to health and social care professionals. The management team were working towards creating a positive culture within the home.

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 good (published 19 April 2019).

Why we inspected

We received concerns in relation to staffing and management of the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. 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 good to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. 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.

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.

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

Enforcement and Recommendations

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

We have identified breaches in relation to people’s safety, protecting people’s liberties, and the management of the service at this inspection.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

We found the following examples of good practice.

There were clear polices and processes in place to enable people to have family members visit them at the home. People were supported to understand the need for personal protective equipment, social distancing and how to keep safe. Staff had been trained in procedures including how to use Personal Protective Equipment, handwashing and how to minimise the risks from Covid-19. There were systems in place to ensure the home was clean and maintained. The manager was supported internally by staff and others and from external agencies to stay up to date on current guidance.

People’s experience of using this service:

•People were supported by staff they knew and there were enough staff to ensure people received timely personalised care that met their needs.

•The providers quality checks supported the service to continually improve. Lessons were learnt when things had gone wrong.

•People’s needs were assessed to ensure they could be met by the service.

•Staff were recruited safely and received the training they needed to be effective in their roles.

•Risk associated with people’s care was effectively managed. People felt safe and were protected from avoidable harm.

•Staff cared about people and understood their individual needs.

•End of life care was provided sensitively and respectfully and in line with people’s wishes and beliefs.

•Medicines were managed and administered safely.

•People and relatives were involved in planning and agreeing their care. Care plans were detailed and up to date.

•The management and staff team worked in partnership with health and social care professionals to improve outcomes for people. People had access to healthcare professionals when needed.

•Staff felt valued and supported by the management team.

•Feedback from people, relatives and staff was used to drive continuous improvement.

•Complaints were managed in line with the providers policy and procedure.

•Activities of interest were available to people and further activities based on people’s preferences were being developed.

•Regular safety checks of the building and equipment were undertaken. However, timely action had not always been taken to rectify issues identified.

•People’s nutritional and hydration needs were met. Staff followed health care professional’s recommendations to support people with food and drink that maintained their well-being.

•The environment was clean, and staff followed good infection prevention and control practices.

•People received information in a way they could understand and were supported to make choices about how to live their lives in the least restrictive way possible.

•Most staff respected people’s rights to privacy and dignity and promoted their independence.

•People and relatives were positive about the service provided and the way the service was managed.

Rating at last inspection: Requires Improvement (report published April 2018)

Why we inspected: This was a scheduled inspection based on the previous rating.

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

Coundon Manor is a nursing home. People in care and nursing 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 maximum number of people the home can accommodate is 74. The home is a two storey building. People who lived with dementia were supported on the ground floor, and people who were being re-habilitated from hospital on short term contracts, and those living at the home who had more physical nursing needs were supported on the first floor.

At our last inspection the home was placed into Special Measures. This was because we had rated the key questions of 'safe,' ‘responsive’ and 'well-led' as inadequate. There were seven breaches of the Regulations. At that time we met with the provider and they provided us with an action plan. This showed what they would do and by when, to improve all areas of the service we had concerns with to at least 'good'. The provider liaised with us by updating the action plan informing us when they had achieved their aims and what outcomes continued to require improvements.

During this visit the provider had made a promising start to improving the service and the home was no longer in breach of the regulations, and no longer in special measures.

Because it had only been four months since our last visit we were aware the provider had not had a significant period of time to move the home forward and sustain improvements made. The provider also shared this view. They had also been made at a period of time when there were less people in the home than usual. This was because the provider had volunteered to stop admitting new people to the home until improvements were made.

At our previous inspection to the service, 70 people lived at Coundon Manor; during this visit 49 people lived at the home. Improvements were required to be sustained over a period of time once further people were admitted to the home.

The registered manager had been the registered manager at Coundon Manor since 2016. 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.

Staffing levels had increased, and there had been a reduction in the high number of agency staff used. New staff were still becoming familiar with the service and the needs of people who lived at the home. Staff were deployed in specific areas of the home to supervise people in order to promote people's safety and to reduce the risks of people falling.

Care records provided more detail about people, and risks related to people's health and well-being were now being appropriately assessed and acted on. New equipment had been bought to improve the responsiveness of care and to reduce people's risks.

The premises and equipment were clean.

The mealtime experience had improved and people who were at risk of malnutrition or dehydration were getting more support from staff to encourage them to eat and drink healthily. Checks were now being undertaken to identify when people had not eaten or drank so staff could provide further encouragement.

Staff now received better access to training and support. Many staff had completed the provider's accredited dementia training and dignity training, as well as the expected health and safety training. We saw improved responses from staff in relation to people with dementia, and in respecting people's dignity and privacy.

Medicines were mostly managed safely, and the provider had a good understanding of what improvements were required to manage medicines more safely and effectively. Staff recruitment procedures reduced the risk of employing staff unsuitable to work in a care environment.

Staff were seen to be supportive of people, treating them with kindness and respect. People's right to privacy and independence was also supported. Staff appeared happy and enjoyed their work.

Staff felt more supported in their roles. Individual supervision sessions were being planned, and the manager was seen as more accessible. Staff had more opportunities to discuss their work issues with management. Staff felt the provider was now supporting them and the service to improve.

The registered manager and staff understood and complied with the Mental Capacity Act regulations and Deprivation of Liberty safeguards. Staff understood how to protect people from abuse and harm.

People now received showers at times they wanted, and had better continence care and support. People had access to healthcare when it was required. People and relatives now had more opportunities to share their opinions about the care provided by the home. Complaints were being managed according to the provider's policy and procedure.

The provider, registered manager and their management team had worked hard to improve the service. They had made a good start. They needed to ensure the improvements made would be sustained over time and when a higher number of people used the service.

Coundon Manor is a nursing home which provides both permanent accommodation, and respite or temporary accommodation to people who require nursing care and specialist dementia care. The maximum number of people the home can accommodate is 74. At the time of our inspection visit, 70 people were staying at the home.

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

When we visited the home in March 2017 we rated the overall service as 'Requires Improvement'; however the majority of our concerns related to the quality of care provided on the ground floor dementia unit. During this inspection we had concerns about the quality of care on both floors.

At this inspection we found the provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 18, Staffing. This was because the staffing levels for the units were the same as they were when we visited in March 2017. The provider had agreed to an increase in staff during the day time, but this had only just been approved and not fully implemented. No increases to night time staffing had been considered and staff were not always available at the times people needed them. People were still at risk because there were not enough staff to meet their needs and manage the risks associated with their care. We had concerns about the level of staff and staff deployment on both floors of the home. There continued to be a high level of staff leaving the provider’s employment at the service and high use of agency staff to cover for staff shortages. This did not promote continuity of care for people who lived there.

The provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 14, Meeting nutritional and hydration needs. During our first visit there had been some improvements such as changes in the structure of mealtimes. People who required support to eat in their rooms, had this support before people who had their meals in the dining rooms were provided with their meals. This gave staff more time to support people with meals. On our second visit this had been changed back to the original routine. Mealtimes were rushed and people at risk of malnutrition were not always receiving the additional food supplements they required. People who could not drink independently were not always getting enough fluid to keep them hydrated.

The provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 9, Person-centred care. The provider continued to have a high turn-over of staff at the home. This meant not all staff had received the 'creative minds' training to support them with dementia care. The home had to use a high number of agency staff and this meant people with dementia were supported by staff they did not know well. There were not enough staff to support people with more person centred activities.

People’s medicines were not always managed well, there were areas of the home and equipment which was unclean; there was insufficient equipment to support people’s safety with moving; and risks to people’s health and safety had not always been acted on appropriately. This meant we found the provider breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 12, Safe care and treatment.

Whilst individual staff were mostly kind and caring to people, we saw and were told of instances where people’s dignity was not respected. This meant the provider breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 10: Dignity and respect.

The provider had a complaints procedure, however many of the complaints had not been responded to in a timely way. Some people felt their concerns were not listened to and addressed by the registered manager. This meant the provider breached the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 Regulation 16: Complaints.

The provider continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 breach of Regulation 17, Good Governance. The provider had not provided sufficient support to the registered manager or monitoring to improve the service. There had been limited improvements since our last visit but changes had mostly been reactive and in response to what other professionals had highlighted, instead of the provider and management team proactively identifying issues and making change happen.

Given the seriousness of concerns identified, the provider decided not to admit further people to the home and stated they would ensure comprehensive re assessments of people’s care needs were undertaken should people look to return to the home following admission to hospital.

The overall rating for this service is inadequate. This means the service is in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

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

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

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

You can see what action we told the provider to take at the back of the full version of the report.

Coundon Manor is a nursing home which provides both permanent accommodation, and respite or temporary accommodation to people who require nursing care and dementia care. The maximum number of people the home can accommodate is 74. At the time of our visit, 69 people were using the service.

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

There were not enough staff on the dementia unit to keep people safe and to respond to people’s dementia care needs and the risks associated with these needs. There were enough staff on the first floor to keep people safe. Since our last inspection the service continued to have a high turnover of staff which meant there had been a high level of agency staff used, but this had reduced significantly in the last two months.

The provider understood their legal responsibilities to apply for deprivation of liberty safeguards for people who did not have capacity to make decisions and whose liberty was being restricted. Not all care staff had received training in the Mental Capacity Act or understood the importance of gaining people’s consent before care tasks were undertaken. It was not always clear why decisions had been taken in a person’s best interest when they lacked capacity.

Staff mostly had a caring approach towards people, but they did not have time to provide care centred on the needs of the person. Care was task focused on both floors of the home. People’s dignity and privacy was mostly respected.

The cook provided different meal options for people, but some people were not offered a choice and staff did not know how to support people who lived with dementia to make food choices. We were concerned that staff on both floors did not have the time to support and encourage people to eat their lunch and tea time meals.

Friends and relatives were welcomed to visit the home at any time during the day or evening, and could spend as long as they wished with the person they visited.

People’s medicines were mostly administered safely and their healthcare needs were met in a timely way.

Most staff had undertaken training to provide them with the knowledge and skills to work with people safely, and staff received management support with individual meetings and team meetings.

The registered manager responded to complaints in line with the organisation’s complaints’ policy and procedure. Most relatives and staff felt the registered manager listened and responded to their concerns.

The provider undertook their own quality checks of the service, and the registered manager undertook monthly audits to ensure people’s health and safety. The checks were rigorous in relation to health and safety issues and in ensuring records were maintained. They were less focused on the ‘lived’ experience of people who lived in the home.

The registered manager had notified us of incidents that affected the safety of people who lived at Coundon Manor. They had also fulfilled their legal responsibilities by completing and returning the Provider Information Return to the Care Quality Commission when requested.

You can see what action we told the provider to take at the back of the full version of the report.

Coundon Manor is a nursing home which provides nursing care for a maximum of 74 people. The home provides care on two floors. People whose primary care need is dementia, are mainly supported on the ground floor, and people with more complex nursing needs are mainly supported on the first floor. Sixty five people were living at the home at the time of our inspection.

The home had a new registered manager. They were appointed in August 2015 and registered with us in January 2016. 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 our previous inspection on 1, 2 and 3 July 2015, we identified four breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. As a result of this inspection the home was put into special measures. We asked the provider to improve staffing arrangements; ensure people’s individual and social needs were met; improve the cleanliness of the home; ensure people received the food and fluids required to maintain their health; and improve their quality assurance systems. The provider sent us an action plan and monthly updates to tell us about the improvements they had implemented.

During this inspection we checked improvements had been made. We found sufficient action had been taken in response to the breaches in regulations. However, there were some areas where further improvements were required. The provider had plans in place for on-going improvements to be made.

Overall, staff were available at the times people needed them. Since the last inspection staffing arrangements had been reviewed and additional staff were available to support people during busy periods. However, we had concerns that reduced staffing levels in the later afternoon and evening meant people might not have such a responsive service to their personal care needs as they did earlier in the day.

There had been significant improvements in the cleanliness of the home. An increase in housekeeping staff meant all areas of the home were clean and tidy.

There were improvements in meeting people’s social and individual needs. An increase in the number of hours provided to support an individual and group activity programme had benefited people’s social and emotional well-being.

In most cases, people received the food and fluids required to maintain their health. An increase in staffing to support meal times ensured that people who required assistance to eat, received the support necessary. Due to their health needs, some people required additional snacks and drinks, but records did not always confirm they had been given.

The home worked well with the dietician, GP, speech and language team, and other healthcare professionals to support people with their healthcare needs.

There had been improvements in the personal care provided to people, however there were still instances when people did not receive the personal care they had requested or required.

At our last visit many people who could use a call bell to call for assistance, did not have one in reach. During this visit, most people’s call bells were in reach and when people used them, staff responded quickly.

People and visitors were complimentary of the staff and the care provided at the home. We saw staff engaged well with people. People looked well presented with clean clothes and hair and people’s privacy and dignity was promoted. Relatives and friends were able to visit the home at any time during the day or evening.

Complaints were responded to appropriately. The registered manager ensured all complaints, both formal and informal were logged centrally to identify any trends or themes and taken action when necessary.

The registered manager understood their responsibilities and the requirements of the Mental Capacity Act and the Deprivation of Liberty Safeguards (permission needs to be sought when a person who does not have capacity has their liberty restricted). However, not everyone had a documented best interest decision to provide information about why restrictions had been applied.

There were improvements in the management of the home. The provider had developed new processes to check the quality of care provided at Coundon Manor. The registered manager had worked hard to improve the standards in the home, recruit new staff, motivate existing staff, and promote an open and transparent culture.

At our last inspection we found concerns with the administration, storage, disposal and recording of medicines, which might have resulted in people not being fully protected against the risks associated with medicines.

During this visit we found effective systems were in place that ensured medicines were managed safely. Staff were able to assure people that their medicines were stored safely and people were found to be receiving their medicines in accordance with the prescriber's advice.

On 9 September 2014 two inspectors visited the home and on 15 September a pharmacy inspector visited the home to check the actions had been implemented.

The registered manager referred to at the front of this report is not the current manager of the service. The registered manager has not yet cancelled their registration with the Care Quality Commission.

During our visit we spoke with the manager, deputy manager, operations manager, 10 staff, five visiting relatives and five people who used the service.

Below is a summary of what we found. The summary describes what people told us, what we observed, the records we looked at and what staff told us. We used the evidence we collected during our inspection to answer five questions.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

We found sufficient staff to meet the needs of people during the day. Because of staff sickness, we could not determine from observation whether there was sufficient staff at night. The provider has agreed to monitor this and report their findings to us in the next six weeks.

We found some errors and omissions in medication management meant people were not always kept safe.

Is the service effective?

People were supported by staff who have the necessary skills and knowledge to meet their assessed needs.

Management had plans to promote good practice and develop the knowledge and skills of existing and new staff.

Is the service caring?

People were treated with kindness in their day to day care. Staff supported people to maintain their dignity, and were respectful when providing care.

Is the service responsive?

The manager had implemented systems which encouraged people to be involved in the planning and review of their care.

The service had an effective complaint's procedure.

Is the service well-led?

The new management team have been in post for a short period of time. During this time they have improved the quality of service provision, and introduced systems which more effectively monitor the quality of care provided.

Since our visit they have acted swiftly to address the new concerns we had regarding medication management.

We looked at five outcomes to answer the following five questions. Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection, speaking with people who used the service, the staff supporting them and from looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with were positive in their comments about the service but we found improvements were needed in the care and support being provided.

People were not always involved in their care. We saw people's care records were not always accurate or sufficiently detailed to make sure people received the care they needed.

Staff had received or were booked onto training about the Mental Capacity Act. This was to improve their understanding of how to support people who lacked mental capacity to make decisions about their care and treatment. The manager told us further work was needed to check if any Deprivation of Liberty Safeguards (DoLS) applications needed to be made.

Effective systems were not in place to make sure staff learned from events such as accidents and incidents, complaints, concerns and investigations.

We found staff were not always knowledgeable about people's needs. We were told by staff that they did not always have time to read care plans. We found the number of staff available to support people and the way staff were organised was not always effective to keep people safe.

There were ongoing problems with people's medicines not being available. We were told this was primarily due to problems in communication between the doctor's surgery and the supplying pharmacy. Although we acknowledged the problem involved a number of agencies, effective action had not been taken to resolve it. We found that people's medicines were not always available to give to people as prescribed. This increased medicine safety concerns. We found appropriate arrangements were not in place to manage the risks associated with the unsafe use and management of medicines.

Is the service effective?

We saw there was a process to assess risks associated with people's care. We found this process was not being managed consistently. We found in particular risks associated with people's nutrition were not always effectively managed.

People had access to a range of health care professionals to support their care needs, some of which, visited the home.

We found some of the equipment needed to support people's needs was not readily available.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. We saw some staff were kind and friendly in their approach. Others were task orientated and seemed rushed and unable to spend time with people. We spoke with a number of people who used the service. People told us they were satisfied with the care and support they received. One person told us, 'I'm very comfortable and well looked after.'

Is the service responsive?

People were able to participate in social activities within the home and within the local community. One person told us, 'They throw balls and do painting.' We saw social activities being undertaken on the day of our inspection.

There was not an effective system in place to manage complaints. This had been identified and the new management team were in the process of addressing complaints received.

We found systems and processes were not in place to analyse accidents and incidents to identify any preventative measures required.

We saw people were able to access help and support from other health and social care professionals when necessary.

Is the service well led?

At the time of our inspection the manager named on this report was no longer in post. A new manager had been employed and was to complete the CQC registration process.

We did not see there was an effective system to monitor the quality of care and services provided. We were told about plans in place to address this. These plans included the implementation of quality audits of the service.

We saw there was a new management team in place at the home. We saw actions were in progress to make improvements across the home. Staff were positive about the actions that the management team had taken since they had been in post.

We found from talking with staff, the manager and reviewing records that arrangements were in place to support staff in developing their skills. Some staff had completed the required training and others had dates identified to complete this.

We found actions had been taken to address the compliance actions issued at our last inspection but further improvements were needed to address staff training, supervision and appraisals. People we spoke with about the staff told us: “Staff have been really helpful.” “Very helpful, very polite, very interested and there are always plenty of them around.”

We saw that people were involved in making decisions about their care. We received positive comments from people and relatives about the service. These included: “It’s very good.” “I find it quite comfortable.” “My impression so far is really good.”

We saw there were appropriate systems in place to manage any allegations of abuse. People told us they felt at ease to raise any concerns with staff if they needed to and staff knew what process to follow if they suspected abuse.

We saw that the service had systems in place to monitor the quality of care and services provided. Comments on completed surveys included: “One of the best homes I have visited for odour free areas.” “The home is clean and tidy and gives an excellent insight into the quality of staff at all levels.”

We found that some people were involved in making decisions about their care to enable them to maintain some independence. We identified improvements were needed in the delivery and maintenance of care to keep people safe. Care records were not always up-to-date to make sure staff managed risks and delivered care that met people’s needs. Improvements were also needed to address people’s privacy and dignity.

Whilst we had concerns about care, people were positive in their comments about the home. They told us: “All very good.” “It’s smashing they are all friendly people.” They were also positive about the staff. Comments included: “Staff are ever so nice.” “They have been very kind to me.”

We observed that staff were rushed in their work and task orientated. We observed incidents of concern involving people living in the home which went un-noticed by staff. This was because staff were busy.

Quality monitoring was not being carried out on a regular basis to ensure people were receiving the quality of care and services they expected.