We undertook an unannounced inspection at Admirals Rest Care Home on 27 November 2018. The last inspection of the service was carried out on 7 October 2017. At that time, we identified several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Shortfalls related to safeguarding people and obtaining their consent, staff training and pre-employment checks. Audits did not always identify the shortfalls found during the inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve in specific areas. At this inspection, we found that necessary improvements had been made.

Admirals Rest 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.

Admirals Rest is registered to provide care for up to five people with mental health needs. At the time of our inspection there were five people living there. Admirals Rest is situated in a large terraced house close to the centre of Bridgwater. The communal areas of the service were all on the ground floor. This included a lounge, dining area and kitchen. Bedrooms were available on all floors, and most bedrooms were en suite.

There was a registered manager employed at the service. 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.

People and their relatives were complimentary about the service, the care received, and the staff team. People were asked for their consent and were supported respectfully.

Staff had received training in safeguarding, and knew what they must do to protect people from abuse or neglect. Systems and processes were in place to protect people from harm and to support staff and the provider had made safeguarding referrals to the local authority appropriately.

The provider ensured that there were enough staff to meet the needs of people, and followed effective recruitment procedures to ensure prospective staff were suitable to work in the service.

There was regular monitoring of fire safety, infection control, incidents and accidents as well as regular equipment checks and maintenance. This ensured the premises and equipment were safe, and risks to people were minimised.

People's medicines were safely ordered, received, stored and disposed of, and were administered as prescribed. Medicines administration records were accurate and clear. Some staff required medicines training or updates.

People were supported to make sure their health and wellbeing needs were met. People’s care records contained personalised risk assessments. These gave staff information about how to support people and ensure risks were managed effectively.

Care records described how people wished to be supported and some personal preferences. People were encouraged to be involved in planning their care and treatment. Where appropriate, relatives told us that they were consulted with and informed about people’s care.

Systems were in place to monitor and review the quality of the service. Audits were up to date, but some were brief. In these cases, the information recorded did not support the provider to make effective quality improvements.

The staff team had recently changed and some staff were new to the service. An induction programme was in place, although staff gave mixed views about this. Staff were caring and patient, and most knew people well. Most staff told us that they received relevant training and support to equip them to carry out their duties effectively.

This inspection was unannounced and took place on 7 October 2017. This was the first inspection for this service.

Admirals Rest provides personal care and support for adults with mental health needs and / or mild learning difficulties. The home is situated within easy reach of the town centre of Bridgwater, Somerset. There are five large, single bedrooms with en-suite or private facilities. There is a communal lounge and dining room; main kitchen; laundry facilities and a sheltered smoking area within a secluded rear courtyard area. At the time of our inspection there were five people living there.

There is 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.

People were not protected from the risk of abuse. Where allegations or concerns had been brought to the registered manager’s attention they had not worked in partnership with relevant authorities to make sure issues were fully investigated and people were protected. The provider did not follow safe recruitment practices; checks had not always been made to ensure staff were suitable to work with vulnerable adults.

Systems and processes around medicines were not reliable and appropriate to keep people safe. Monitoring the safety of these systems was not robust. The registered manager undertook spot checks to review the quality of the service provided, however these did not identify the shortfalls we found.

Staff did not have written guidance how to support people in the event they would need to evacuate for an emergency. Staff had not taken part in fire drills to check they were able to meet people’s needs in an emergency. There were appropriate numbers of staff employed to meet people’s needs and provide a flexible service.

Staff did not have their competency to administer medicines checked and some improvements to medicines management were needed relating to records and storage. Whilst staff received an induction into the service and other additional training, some specific health related training had not been provided.

The staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised by the local authority as being required to protect the person from harm.

Assessments were undertaken to assess any risks to the person using the service and to the staff supporting them. This included environmental risks and any risks due to the health and support needs of the person. The risk assessments included information about action to be taken to minimise the chance of harm occurring.

Staff knew the people they supported and provided a personalised service. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care.

People were supported to eat and drink. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

Staff told us the registered manager was accessible and approachable. Staff and relatives felt able to speak with the manager and provided feedback on the service.

We found three breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009 during our inspection. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been conclud