Archived: Viewpark Care Home Limited

We last inspected Viewpark Care Home on 08 and 09 August 2017 when we rated the home inadequate overall. At that inspection we identified multiple breaches of the regulations, and ongoing and serious concerns in relation to the provision of safe care and treatment. The service was rated inadequate and remained in special measures. At this inspection, whilst we again found evidence of some improvements, these were limited in scope and the provider had not adequately addressed other concerns. We found the provider was now meeting the requirements of the regulations in relation to submitting statutory notifications, care planning and assessment, and safe staffing. However, there remained ongoing breaches of the regulations that meant the provider continued to put people’s health and wellbeing at risk.

We also identified new breaches of the regulations and found previous improvements had not always been sustained. For example, we found repeated breaches in relation to safeguarding and acting in accordance with the Mental Capacity Act. These areas were found to be in breach at out inspection in November 2016, but were compliant at our last inspection in August 2017. We identified multiple breaches of the regulations at this inspection, which were in relation to assessing and mitigating risks to people’s health and wellbeing, the safe management of medicines, safeguarding procedures, supervision of staff, consent, deprivation of liberty safeguards, good governance and acting openly and transparently. We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Viewpark Care Home Limited (Viewpark) 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. Viewpark accommodates up to 27 people in one adapted building. Bedrooms are located on two floors, with a passenger lift between floors. There are two dining rooms, two lounges, and a conservatory. The home is situated in a residential area of Moston in north Manchester. At the time of our inspection there were 17 people living at the home.

At our last inspection we found staff were not following the advice of a professional and were providing food and drinks of an incorrect consistency. This had placed this person at risk of harm through aspiration or choking. Although staff had received training in relation to supporting people to eat and drink, we found staff were still not aware of, and were not following the correct guidance for this person. This meant this person was being placed at ongoing risk of harm.

There were sufficient staff on duty to meet people’s needs. The provider had increased staffing at night from two to three staff. This was due to concerns raised at our last inspection in relation to the support available to evacuate people in the case of an emergency and concerns raised by the local authority relating to the supervision of people at risk of falls. The local authority had placed a block on any local authority funded admissions to the home. This meant the home was not operating at full capacity.

We found ongoing issues in relation to the safe management of medicines. Staff did not always monitor the temperatures that medicines were stored. When temperatures had been monitored, there was a lack of evidence to show the appropriate actions had been taken if temperatures had exceeded manufacturers recommendations. This meant there was a risk these medicines might not work as effectively. The administration of medicines was not always accurately reflected on the medication administration records (MARs).

We found shortfalls in actions taken to ensure the safety of the premises. We found an action identified in the home’s fire risk assessment to ensure combustible materials were not stored on the dryers had not been acted upon. We also found the provider had not obtained a required safety check of the passenger lift. They arranged for this to be carried out during our inspection after we made them aware of this issue.

There were not robust procedures in place to ensure staff employed were of suitable character. We saw two staff members had recorded convictions on their criminal records checks. There was no recorded rationale as to why the provider felt these staff were of suitable character despite these convictions. There were also no risk assessments in place that could demonstrate that consideration had been given to any potential measures that might reduce potential risks to people using the service that the presence of these convictions might indicate.

There had been a recent break-in at the home where the home’s safe was stolen. The provider had not replaced the safe after several weeks, meaning people’s money was not always kept as securely as it could be. Staff were not following the home’s financial procedures policies and people were at increased risk of financial abuse as a result.

People told us they enjoyed the food on offer. We saw people were offered a choice of meal and received encouragement and assistance to eat their meals. Good practice in relation to supporting people in a person-centred way over meal-times had been given by the registered manager. Staff had made referrals to dieticians or a person’s GP when they identified people might be at risk of malnutrition.

People living at the home were positive about their relationships with staff who they told us were kind and caring. We saw staff had time to meet people’s needs and interact with them socially. However, there were also missed opportunities for staff to engage with people and to set up activities.

Staff understood the importance of respecting people’s privacy and dignity. There had been issues at the home with staff passing on confidential information about people using the service to other people outside the home, including former staff. The provider had addressed these issues with the staff team and asked them to sign to say they understood the policies on confidentiality and social media use.

The provider had submitted deprivation of liberty safeguards (DoLS) applications for all people living at the home. However, this was not appropriate as at least one person had mental capacity. This meant they were at risk of their liberty being restricted unlawfully. The provider was not always acting in accordance with the Mental Capacity Act 2005.

Care plans led staff to complete comprehensive assessments by following a check box process. Information was also recorded on how to meet people’s needs, along with details about their interests, preferences and social histories. However, this information was recorded with a variable degree of detail. People were not aware of having been given opportunity to be involved in developing or reviewing their care plans, and there was no documentary evidence of such involvement.

The home had employed an activities co-ordinator for two days per week since our last inspection. Although we saw limited activities taking place during the inspection, people gave us positive feedback about the activities on offer. We saw past activities had included visits from entertainers and baking sessions. Staff helped protect people from social isolation by running events such as buffets and meals for people’s birthdays and Christmas. They also encouraged interaction between people by setting up games people could play together.

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. Since our last inspection, the deputy manager had left, and the registered manager was now supported by a ‘team leader’.

There had been multiple whistleblowers to CQC and the local authority since our last inspection. Issues raised included concerns about the registered manager’s treatment of staff. Staff during our inspection told us the registered manager was approachable and supportive. However, we also found evidence that supported whistleblower claims that the registered manager did not always treat staff with respect. Although the provider was in regular contact with the registered manager, there had been no formal supervision provided to them, despite ongoing concerns being raised about the service.

The provider was unaware of their responsibilities in relation to the duty of candour, which requires services operate in an open and transparent way. We also received evidence that staff within the service had not always acted open and transparently in relation to issues arising in the service.

The systems in place to monitor and improve the quality and safety of the service were not effective. They had not ensured that all previous improvements had been sustained or that the provider was meeting the requirements of the regulations. We identified ongoing issues from previous inspections and ongoing breaches of the regulations.

This is the third consecutive time that the overall rating for this service has been ‘Inadequate’, and the service remains 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 inadeq

We last inspected this service on 23 November 2016 when we identified multiple breaches of the regulations, rated the service as inadequate overall and placed the service in special measures. At this inspection we found some limited improvements had been made, and the service was meeting the requirements of the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to breaches relating to the display of their rating, safeguarding and deprivation of liberty safeguards (DoLS), and dignity and respect. However, we identified ongoing and serious concerns in relation to the provision of safe care and treatment, assessing and acting to reduce risks to people’s health and wellbeing, the safe management of medicines, care planning and assessment, safe staffing, governance and records. We also identified a new breach of the regulations relating to failure to notify the CQC of a serious injury. We are currently considering our options in relation to enforcement and will update the section at the back of this report once any enforcement action has concluded.

We have made one recommendation in this report. These relate to following the Mental Capacity Act code of practice and associated guidance.

Viewpark Care Home Limited is a purpose built residential care home registered to provide care

and support to 27 older people. There were 26 people living in the home on the day of our inspection. Bedrooms are located on two floors, with two lifts and two staircases between the floors. There are two dining rooms, three lounges, and a conservatory. The home is situated in a residential area of Moston in north Manchester.

At the time of our 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.

We identified concerns with the way the service identified and managed risks to people’s health and wellbeing. Risk assessments were not always up to date and staff were not always acting on the advice of professionals. For example, staff were not following advice in relation to one person’s dietary requirements, which put them at risk of choking.

The service had introduced a new electronic medicines management system. However, we found people had not always received their medicines as prescribed. Checks of medicines had not identified or ensured timely actions were taken to address any potential medicines errors. We also observed staff did not always follow safe and hygienic practices when administering medicines.

We observed that people received support promptly when they required it. Since our last inspection a new cook had been recruited. This allowed staff more time to provide support to people as they weren’t required to assist with food preparation in addition to their care duties. Whilst staff and people living at the home felt there were enough staff to meet people’s needs, we were concerned that a review of night staffing levels had not taken place as recommended by a fire risk assessor.

Staff were aware how to identify and report any safeguarding concerns they might have. We found the service had made referrals to the local authority safeguarding team and other agencies as required in relation to any instances of alleged abuse or neglect.

People told us they found staff competent and knowledgeable. Staff said they received sufficient training to enable them to meet people’s needs. Training records showed staff had received training in a range of relevant topics, which would help them provide effective care to people living at the home.

We received positive feedback from people about the food provided. People had a choice of meal and could request and alternative if they wished. We saw staff monitored people’s weights if required and people told us they were confident staff would contact their GP or other health professionals if they were unwell.

Despite feedback at our last inspection, the service had continued to use ‘blanket’ capacity assessments that were not decision specific. This increased the risk that people who were able to make certain decisions in relation to their care might not be given opportunity to make these choices. One person was being given medicines without their knowledge. Although we were assured this decision was made in consultation with others in this person’s best interests, there was no formal record of this.

We received positive feedback from people living at the home and visitors about staff who we were told were friendly, caring and approachable. During the inspection we observed positive examples of staff communicating clearly and respectfully with people.

The home used CCTV and the network of cameras was being increased at the time of our inspection. The registered manager told us this was in response to recent safeguarding concerns to enable staff to be monitored. Cameras covered all communal areas including corridors and lounges. People living at the home and visitors we spoke with were unaware of the CCTV system. However, they all told us they felt it was a good idea to help keep people safe.

A new format of care plans were in the process of being introduced at the home. We found people’s care plans contained variable levels of detail about people’s preferences and how staff should meet people’s needs. Some care plans lacked details about how staff should provide people with support, which increased the likelihood that appropriate care that met people’s needs and preferences would not be provided.

Three people had moved into the home on an emergency basis two days prior to the second day of our inspection. We found no care planning or assessment of needs had been undertaken by the home. Staff had not completed any risk assessments and no records had been put in place in relation to these people’s medicines. Staff were not aware whether one person had been administered a ‘when required’ medicine and the lack of any record meant there was a risk of them being given this medicine too frequently.

We received mixed feedback from people as to whether there were enough activities provided at the home. During the inspection we observed an external company supported an activity that engaged a number of people. Staff set up activities for other people such as colouring.

Some improvements had been made to the environment since our last inspection to make it more dementia friendly. This included making people’s bedroom doors different colours and changing the colour of the bathroom doors. A secure garden area was also being developed that people would be able to access. This would help people orientate around the home and allow them to access outdoor spaces safely.

Staff and visitors told us the registered manager was approachable and listened to them. During the inspection we saw staff regularly entered the office and discussed any issues or requested advice from the registered manager, which was provided.

There had been limited improvements to the quality assurance and audit processes in place to monitor and improve the quality and safety of the service. We found checks carried out were still not effective at identifying issues or driving improvements. The registered manager relied on the electronic medicines management system to identify any medicines errors or other issues in relation to the safe management of medicines. However, there was no evidence that where the system had identified errors that any action had been taken to investigate or rectify these issues.

We found evidence that the registered manager had not submitted all required notifications of serious injuries to the CQC as is a legal requirement. We had identified a similar issue at our inspection of the service in June 2015. This showed a failure to act effectively on feedback to make improvements to systems and processes.

The overall rating for this service is ‘Inadequate’ and the service therefore remains 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.

Viewpark Care Home Limited (Viewpark) 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. Viewpark accommodates up to 27 people in one adapted building. Bedrooms are located on two floors, with a passenger lift between floors. There are two dining rooms, two lounges, and a conservatory. The home is situated in a residential area of Moston in north Manchester. At the time of our inspection there were 13 people living at the home.

Our last inspection of Viewpark took place in January 2018 when we rated the home Inadequate overall, and identified multiple breaches of the regulations. At this inspection we again found evidence of limited improvements. However, there were still considerable improvements that needed to be made to the service. We found improvements had been made and the provider was now meeting the requirements of the regulations in relation to employment of fit and proper persons, safeguarding, need for consent and the duty of candour. However, there remained ongoing breaches of regulations, including in relation to staff training, person-centred care, good governance and multiple breaches in relation to safe care and treatment. We also identified a new breach of the regulations in relation to treating people with dignity and respect. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to the back section of reports after any representations and appeals have been concluded. We also made a recommendation that the service strengthens their practice in relation to implementation of the Mental Capacity Act 2005.

There was no registered manager in post. The former registered manager had left the service in March 2018. Shortly after this CQC completed enforcement action to cancel their registration as a manager at this home. The provider had employed a new manager. However, they told us they did not intend to register as the manager of the home, and did not plan on staying in post long-term. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The directors of the company that owns Viewpark were not actively involved in the day to day running of the home, and a family member of the directors was acting on their behalf. The manager told us they did not feel they were provided with enough support or resource to enable them to make the significant improvements required at the home. Whilst the provider’s representative was actively involved in the running of the home, they did not have a background in social care provision and so were still learning about how to run a care home.

We found the provider had made some improvements to procedures in place to help ensure people were kept safe. For example, risk management in relation to pressure ulcers and providing the correct consistency of food and fluids to people had improved. However, we continued to find examples of when staff had not taken reasonable actions to reduce potential risks. An inspection of a bath chair had found it to be unsafe to use. However, there was nothing in place to inform staff or others of this, and there was a risk it could have been used inadvertently. Water temperature records showed some outlets were too hot, and could present a risk of scalding. There was no evidence that staff had taken any action to address this issue, or control the risk this presented to people prior to us raising the concern.

Recording and monitoring of accidents and incidents had improved. However, there was scope for monitoring of any trends or patterns in accidents to be strengthened. Staff identified ways to help keep people safe and prevent a re-occurrence of any accident. However, staff followed identified risk reduction measures inconsistently. For example, one person should have had hourly observations from staff to help manage their falls risk. However, staff had incorrectly understood that these checks had been discontinued.

There were continued concerns in relation to the way the service managed medicines. We found some people had run out of stock of pain relief, and staff did not have sufficient knowledge about how people’s medicines should be given. For example, staff did not understand requirements in relation to rotation of medicines applied by a patch, which is required to reduce the risk of skin irritation. Staff had also failed to ensure there were adequate gaps between administration of doses of paracetamol, which could have a negative impact on people’s health.

We found some areas of the home where good standards of cleanliness had not been maintained. We also found a seat protector that appeared to be wet with urine was left in communal areas for several hours until we brought this to the attention of staff. We found few, and at some points in the inspection, none of the hand sanitiser dispensers were working. This would increase the risk that good hand hygiene would not be maintained, resulting in an increased risk of spread of infection.

There had been a continued embargo on placements at the home by the local authority since our last inspection. The manager told us they had found it hard to recruit staff with the required skills for the job, and the home was using agency staff to cover any shortfalls on the rota. During the inspection we saw staff were attentive and had time to spend with people. However, on the afternoon of the second day of our inspection there were two agency staff on duty, along with a senior member of care staff and a newly recruited member of staff. One member of agency staff needed a lot of direction from the senior carer, and we questioned the skill mix of the staff team at that time. The provider told us this was not usual to have such a staff team on duty, and rotas confirmed this.

Staff had received training in a variety of relevant topics, including recent training in use of thickening agents and pressure care. However, not all staff had received training that it would be important for them to receive to help ensure people received safe and effective care, such as safeguarding and infection control training. No progress had been made since our previous inspections in relation to providing staff with training in end of life care.

We also identified concerns with the way the provider had promoted staff to new roles. We reviewed records relating to one staff member and found no evidence that the provider had given reasonable consideration as to whether the staff member was competent and had the skills to undertake the new role. They had also not assessed whether the staff member required any additional training or support to enable them to work effectively in this new role.

Staff understood the principles of the Mental Capacity Act 2005. We saw staff asked people for their consent before providing any care, and respected people’s wishes. Staff routinely offered people choices such as what they had for their meals. However, documentation in relation to best-interests decisions needed to be strengthened.

There were several adaptations to the home to make it more accessible to people living with dementia. However, limited opportunities were made available for people to access any outside areas during warm weather. Staff also told us the large garden at the rear of the home was not used as the ground was uneven and presented a trip hazard.

Entertainers visited the home, and staff supported people to take part in ad-hoc activities such as ‘singalongs’ or they provided colouring materials for example. However, there were limited opportunities for people to access their local community or activities outside the home.

The manager was in the process of re-designing people’s care plans. We found there were multiple versions of care plans, which made it hard to tell which was the most up-to-date information. Whilst people’s care plans contained information regarding their preferences and social histories, there was no evidence to support that such information was used in a meaningful way to enable staff to provide person-centred care.

Permanent staff knew the people living at the home well. We saw staff interaction with people had improved, and we observed staff acting in kind and caring ways that showed consideration for people’s wellbeing. However, improvements were needed to the way staff upheld people’s privacy and dignity. For example, we found people did not have their own personal toiletries, and instead used stock from a communal supply. We also observed one person was spoken to in a derogatory manner by another person living at the home. Staff did not appear to be aware of this and did not intervene.

Whilst there had been some improvements to how the provider and manager monitored the safety and quality of the service, there remained concerns in this area. The audits and checks carried out had not identified all the issues we found, such as in relation to medicines management. Other audits had identified issues, but had not resulted in improvements.

The overall rating for this service is ‘Inadequate’ and the service remains 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 time

The previous inspection took place on 29 June 2015. At that inspection we found breaches of six regulations. The concerns we identified were as follows: The controlled drugs cabinet was not made of the right material and was not affixed to a solid wall. The service had not reported the outcome of Deprivation of Liberty Safeguards (DoLS) applications. Confidential information about people was not being kept securely. Care files were disorganised and did not ensure people’s needs could be understood. The service had failed to submit notification of three allegations of abuse and several serious injuries. There was not an effective system of audit of care files and medication.

The registered manager submitted an action plan stating how the service would become compliant in those areas. At this inspection we checked whether the service was now complying with the relevant regulations.

Viewpark Care Home Limited (‘Viewpark’) is a purpose built residential care home registered to provide care and support to 27 older people. There were 25 people living in the home on the day of our inspection. The bedrooms are on two floors, with two lifts and two staircases. There are two dining rooms, three lounges, and a conservatory. The home is situated in a residential area of Moston in north Manchester.

The service had a registered manager who had been in post since September 2013 and became registered in June 2014. 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.

We looked at the management of medicines. We found that medicine storage fridge temperatures had not been recorded for three months. We found a number of errors relating to the recording of medicines, which indicated that people might not have received the correct doses. This was a breach of the regulation relating to the management of medicines.

Most staff had received training in safeguarding and understood the principles involved. We discovered a potentially serious safeguarding incident had not been recorded, and had not been reported to the local safeguarding authority. This was a breach of the regulation relating to responding to incidents of abuse or alleged abuse.

Staffing levels during the day were affected by the absence of a cook. We learnt of other recent occasions when the number of staff on duty had been reduced. There were two staff on duty at night and we found evidence of occasions when this was insufficient to safely meet the needs of people who used the service. We found there was a breach of the regulation regarding having sufficient staff on duty.

We have made a recommendation about analysing and learning from accidents and incidents.

Recruitment procedures were in place to ensure suitable staff were employed. There were cleaners on duty but we saw examples where the level of cleanliness could have been better. There had been an outbreak of a sickness bug in October 2016 but this could not be attributed to poor infection control.

The heating had been unreliable but was being fixed. There was routine maintenance of the building and equipment. There were systems to reduce the risk from fire although the register of evacuation plans required to be updated.

Staff had knowledge of the Mental Capacity Act 2005 (MCA) and we saw examples of them asking for consent before providing care. Mental capacity assessments were used although they needed to be used for specific decisions rather than as a blanket test of capacity. Best interests decisions had been made but not in every case. Letters were on file from GPs authorising covert medicines without a recorded best interests decision. However, the registered manager told us no covert medicines were currently being administered.

The registered manager had previously notified us about Deprivation of Liberty Safeguards (DoLS) authorisations. We saw one person required a DoLS application to be made, but this had not been done. This was a breach of the regulation relating to depriving people of their liberty without lawful authority.

There was no cook on the day of our visit. Lunch was a cooked breakfast, and tea was fish and chips from a local takeaway.

People were being weighed regularly but the results were not analysed to identify any risks associated with weight loss. This was a breach of the regulation relating to assessing risks to the safety of people living in the home.

Training was undertaken and we saw evidence of ongoing training courses. Staff had supervisions with the deputy manager but appraisals were overdue.

We have made a recommendation that the provider should research ways to improve the physical environment for people living with dementia.

People living in the home and their relatives were appreciative of the care provided. We saw some kind interactions between staff and people. However we also saw several examples of a lack of respect and where people’s dignity was not being maintained.

Some inappropriate language about people was used, including in care plans. In some respects people’s independence was limited. These examples were a breach of the regulation relating to treating people with dignity and respect.

The confidentiality of documents had improved since the last inspection.

We looked at care records. They contained an “All about me” document but they had not all been completed. Other parts of the care plans did not provide enough guidance to staff on how to meet people’s needs. Reviews of care plans were sporadic and had not identified and addressed the lack of detail about how staff should meet people’s needs.

One person who had recently arrived in the home did not have a proper care plan, although there were some notes about them. We found a breach of the regulation relating to assessing people’s needs and designing care to meet them.

Not all significant events had been recorded and there was no evidence appropriate referrals to health professional had been made. This was a breach of the regulation relating to keeping records.

There was no activities organiser in post, but we were told there had been one until three months prior to our inspection. Very few activities were taking place, although there were some dolls available which can be therapeutic for people living with dementia.

The lack of activities was a further breach of the regulation relating to meeting people’s needs.

A survey was available for families to complete. Meetings were held for people living in the home to express their views. No formal complaints had been received within the past year.

The rating from our last inspection was not being displayed in the home, which was a breach of the relevant regulation.

Medication audits were not reliable because the answers were duplicated from one audit to the next. Care plan audits lacked depth and had not been improved since our last inspection. This was a breach of the regulation regarding assessing and monitoring the quality of the service.

Staff expressed to us concerns about the support they received from management. Staff morale was low. Although we did not discern any impact on the people living in the home, we were concerned that it might have an impact unless morale improved. The last all staff meeting had been six months earlier.

The registered manager had reported notifiable events to the CQC.

We found breaches of seven regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

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

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

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.

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.

Below is a summary of what we found. The summary is based on our observations, talking with people living in the home and their relatives, with staff and with the acting manager. We also looked at care records and other files and considered information sent to us by other professionals.

The evidence that supports our summary can be found in our full report.

Is the service safe?

One relative wrote in a survey: "I feel that my mother is safe, which gives me peace of mind." The home was clean and hygienic and people looked well-cared for.

We found that one incident which occurred in December 2013 ought to have been reported as a safeguarding concern to the Care Quality Commission. It had also not been properly reported to the local authority. This meant that the home had not responded appropriately to a safeguarding concern and therefore failed to keep people safe. We considered that this had a moderate impact on people living in the home and have asked the provider to submit an action plan stating how this will be put right in the future.

We also found that some aspects of the maintenance and layout of the premises were unsafe. We have asked the provider to tell us how they are going to put them right.

We learnt that at the date of our visit no mental capacity assessments had been done. The manager told us that in her opinion the majority of people lacked capacity. Assessments were going to be completed soon. This meant that at the date of our visit no applications for authorisations under DoLS (the deprivation of liberty safeguards) had been made.

Is the service caring?

We saw that people were well looked after. The staff clearly knew people well, and were attentive to their needs. The care plans were very thorough although we found they would benefit from some editing to remove duplication and contradictions, and make them easier to read.

We talked to relatives who were all full of praise for the quality of the care provided. Those who had completed a survey expressed the same approval.

Is the service responsive?

We saw that one comment made by a relative in the survey had been addressed by the home. The acting manager told us she had an open door policy and both staff and relatives were welcome to approach her at any point. We learnt that menus had been altered at the request of people living in the home.

Is the service well-led?

The acting manager was in the process of applying to become the registered manager. She had been in post for seven months and told us she was still implementing changes. Aside from the information relating to safeguarding, mentioned above, we found no evidence of concern relating to her ability to lead the service. The three senior care workers were experienced and formed a strong team to support the manager.

Is the service effective?

For the people who for the most part were living with dementia the service was effective in caring for their needs. Their physical needs were cared for, the food was nutritious and wholesome, and staff were caring and compassionate. Staff were being well supported to deliver care, although training in certain areas needed to be more thorough.

At the last inspection on 15 April 2013 we found minor concerns in relation to the way information was recorded about the people who used the service. Records did not always demonstrate clearly the plan of care provided, and daily observation records did not reflect details of the way people were cared for.

At this inspection we found the provider had improved this outcome area. More detailed information was now recorded about how staff supported and cared for the people who used the service. A record of health care appointments was held and daily observation records now included more detailed information about people's wellbeing. This meant the provider had taken steps to ensure information about people was recorded appropriately and staff had been given information about the way people should be supported.

People said they enjoyed the meals and confirmed a choice was available at mealtimes. One person said, 'If you don't like what's available, you tell them and they'll give you something else'. Another person told us, 'No complaints about food ' I accept things as they come. People can only give you what they can afford to give you. They're doing ok here as long as you can accept that'.

Staff were aware of the different types of abuse that could take place and the signs to look out for. None of the staff had any concerns about the safety and welfare of the people they looked after.

A complaint procedure was available to the people who used the service and their relatives so they knew what to do if they were unhappy with the standard of care they received. One person said, 'I would speak to a senior member of staff if there was anything I wanted to change'. Another person told us, 'I have no complaints about living here'.