This inspection took place on 17 and 18 September 2018. The first day was unannounced.

Ailwyn Hall is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Ailwyn Hall is registered to accommodate up to 39 people. Care is provided over two floors. There are communal areas that people can reside in along with space for dining on the ground floor. At the time of our inspection visit, 18 people were living in the home.

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

At the last inspection of Ailwyn Hall in February 2018, we rated the home overall as Inadequate. This was because: risks to people’s safety had not been adequately managed; systems to protect people from the risk of abuse were not robust; consent had not been sought from people in line with the relevant legislation; some areas of the premises and equipment people used was unclean; staffing levels were not consistently adequate and staff had not received appropriate training to provide effective care; the governance processes in place were not robust at identifying issues or improving the quality of care provided to people and the provider had not ensured they had notified the Care Quality Commission (CQC) of notifiable events as is required by law. This resulted in six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the CQC registration regulations 2009.

Following that inspection visit, we took urgent action to protect people from the risk of harm. This was in the form of placing a condition on the provider’s registration. This condition prevented them from admitting people into the home and told them they must send us a weekly report detailing how they were managing specific risks to people’s safety. We also placed the home in special measures. Services that are in special measures are kept under review and inspected again within six months from the publication of the report. We expect services to make significant improvements within this timeframe.

The provider had complied with the additional condition we had placed on their registration and at this inspection we found that significant improvements had been made. The provider was no longer in breach of any regulations. The overall rating of the home has changed from Inadequate to Good. Due to this, the home has been taken out of special measures. However, although systems were in place to monitor the quality of care provided to people and any areas for improvement that had been identified had been acted upon, the provider has not consistently met and therefore maintained the required standard of care to ensure that people consistently receive a good level of care. This is why we have rated well-led as requiring further improvement.

Risks to people’s individual safety had been assessed and managed well. Staff had acted to mitigate the risk of people experiencing harm as much as possible.

Systems were in place to reduce the risk of people experiencing abuse. Where incidents or accidents had occurred, these had been thoroughly investigated to try to prevent them from re-occurring.

People received their medicines when they needed them and there were enough staff to keep people safe and to meet their needs. The home was visibly clean as was most of the equipment that people used.

The staff had received appropriate training and supervision to provide people with safe and effective care. The staff were kind, caring

This inspection took place on 5, 7 and 13 February 2018. The first and third days were unannounced.

During our last inspection in May 2017, we found five breaches of Regulations. These had been in respect of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. This was because risks to people’s safety had not always been managed well or safeguarding incidents reported or investigated appropriately. There was also a lack of staff to meet people’s needs and the provider’s governance systems had not been effective at assessing and monitoring the quality of care people received. Furthermore, the provider had failed to ensure that the Care Quality Commission (CQC) had been notified of certain incidents as is required by law.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of Safe, Effective, Responsive and Well Led to at least Good which was received from them. However, the actions the provider said they would make had not all been implemented.

At this inspection, we found that the provider remained in breach of Regulations 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009. Furthermore, two new breaches of Regulations 11 and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to consent and the premises and equipment people used were also found.

We have also made a recommendation regarding the manager and provider familiarising themselves with the Accessible Information Standard. This standard was put in place in 2012 to ensure that people had access to appropriate information to meet their individual communication needs.

Following the first two visits to the home on 5 and 7 February 2018, we wrote to the provider and told them they needed to take urgent action to protect people from the risk of harm. They responded to us and said what they had done to comply with this direction. However, when we revisited them on 13 February 2018 we found that sufficient action had not been taken in all areas to protect people. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and therefore we are placing the service 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.

This inspection took place on 10 and 11 May 2017, and was unannounced.

Ailwyn Hall provides accommodation and support to a maximum of 39 older people, some of whom were living with dementia. It is not registered to provide nursing care. At the time of our inspection there were 22 people living in the home.

At the time of our inspection visit a registered manager was not 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 last inspected this service on 10 and 14 November 2016 and found widespread and serious issues throughout the service. The provider was in breach of five regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. As a result of our November 2016 inspection the service had been placed into special measures. We carried out this inspection to check if the improvements had been made in order to achieve compliance with the regulations.

This May 2017 inspection found that improvements had been made. The provider had commissioned an independent consultant to provide support and carry out audits to monitor and identify where improvements were required. A new manager had been appointed to the home in January 2017 and a number of actions had been taken to drive improvements. We found these measures had achieved some success and progress had been made to improve the home which had benefited people living there. Whilst the provider acknowledged there was further work still to be done, they had stopped the decline in the service that our previous inspection had found and had begun to implement positive changes.

As a result of the improvements we found it was determined that the service is no longer in special measures. Given the recent history of the service we will inspect the home again within six months to ascertain whether the improvements made have been sustained and whether progress continues.

This inspection found that there continued to be some concerns with the management of risk to people’s safety and wellbeing. This meant the provider remained in breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found some incidents which had not been appropriately identified as adult safeguarding incidents and had consequently not been reported as required. This meant the provider was in breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The provider had reviewed staffing levels and subsequently increased them. However, we found on some occasions the home was not being staffed to these levels which meant there was not always sufficient staff to meet people’s needs. This meant the provider remained in breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Whilst improvements had been made to the governance in the home, we found further improvements to the quality of audits and monitoring of improvements in the home were needed. This meant that at this inspection the provider remained in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found the provider had not always notified us of events in the home as required. This was a breach of Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Improvements had been made in this area. The provider had reviewed possible restrictions in place r

This inspection took place on 10 and 14 November 2016, it was unannounced.

Ailwyn Hall provides accommodation and support to a maximum of 39 older people some of whom were living with dementia. It is not registered to provide nursing care. At the time of our inspection there were 30 people living in the home.

At the time of our inspection visit there was 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 last inspected this service on 10 and 11 May 2016 and found widespread and serious issues throughout the service. The provider was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We issued a warning notice in respect of regulation 17 which set out the improvements required to systems for leadership and governance. We gave the provider until 16 August 2016 to meet the legal requirements in relation to this warning notice. Following the inspection in May 2016, the provider sent us a plan to tell us about the actions they were going to take to meet the above regulations. They told us they would be compliant by 16 August 2016.

We carried out this inspection to check if the improvements had been made in order to achieve compliance with the regulations and in response to concerns reported to us. At this inspection we found sufficient improvements had not been made. The provider was no longer in breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, we found that few effective measures had been implemented to rectify the breaches found at the previous inspection. The provider was still in breach of regulations for: safe care and treatment, staffing, the need for consent, meeting nutritional and hydration needs, good governance and notifications of serious incidents. We found that in some areas, such as medicines and the management of risk, there had been a further deterioration. This meant that risks to people had increased.

We found people were not being provided with safe care. Risks to people’s health and safety were not always identified. We found in cases where risks had been identified insufficient action had been taken to manage and mitigate the risk of any further harm. The systems in place had also not identified risks to people from the premises.

We found there had been deterioration in the management of medicines in the home. Medicine administration charts were not completed correctly and did not show people had been given their medicines as prescribed. There was a lack of guidance for staff on how to administer medicines. Insufficient action had been taken to manage the risks to people when they refused their medicines.

Although the provider had increased staffing levels, there were still occasions when shifts were not staffed in line with the numbers the provider had identified as being needed to meet people’s needs. We found the provider had not ensured suitability trained and qualified staff were deployed in the home. This was because none of the staff working on some shifts had training in areas such as fire safety or first aid.

We found that the numbers of staff who had received training in certain areas had decreased since our last inspection. The induction for new staff was poor and we found some staff had started work in the home without a full induction.

The provider had not ensured that they acted in accordance with the Mental Capacity Act (2005) (MCA). As a result, we found that staff were sometimes making decisions for people without their involvement or consent. The registered manager had

This inspection took place on 10 and 11 May 2016, it was unannounced.

Ailwyn Hall provides accommodation and support to a maximum of 39 older people some of whom were living with dementia. It is not registered to provide nursing care. At the time of our inspection there were 34 people living in the home.

We last inspected this service on 16 and 23 October 2014 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations. The provider was in breach of the Regulation 10 which corresponds with Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014). This was because there was no effective system in place to assess and monitor the information contained in the home’s records. This included information contained in people’s care records.

Following the inspection in October 2014, the service sent us a plan to tell us about the actions they were going to take to meet the above regulations.

At our inspection in May 2016, we found 6 breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and 1 breach of the Care Quality Commission (Registration) Regulations 2009.. You can see what action we told the provider to take at the back of the full version of this report.

There was a manager in post who had been appointed in January 2016. At the time of our inspection, the manager had not submitted an application to the CQC to become 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.

We found that there were continuing issues regarding the governance and quality monitoring of the service. The provider’s quality monitoring had failed to identify issues regarding the documentation of people’s care needs. We found these were not always accurate or detailed enough. The manager did not have a full understanding of their responsibilities and had not always taken the required actions.

Staff were positive about the manager and the support they provided. Whilst not all issues within the home had been identified the manager had taken steps to address some issues and make some positive changes in the home.

People were not protected from avoidable harm and abuse because staff did not always identify and take action to manage situations that placed people at risk of this. Safeguarding incidents were not always reported to the relevant authorities.

Whilst the service identified some risks to people and took action to manage these, not all risks to people were adequately identified or managed. Staff did not always take action when they should to manage the risks associated with people who displayed challenging behaviour. There were frequently insufficient suitably skilled staff available to meet people’s needs and keep people safe.

People living in the service were not always receiving their medicines as prescribed and prescribed external medication was not stored securely. Other practices around medicines were followed safely.

Not all staff had received the training they needed in order to meet people’s needs. The manager did not have sufficient knowledge of the Deprivation of Liberty Safeguards (DoLS) and the home was not working within the requirements of the Mental Capacity Act 2005.

People and their relatives were complimentary about the quality of food provided. However, people were not always given the support they needed in order to eat and drink. Whilst some people were offered choice regarding their meals this was not always consistent.

The home ensured people had access to appropriate health care professionals when required.

Whilst staff knew people living in the home well a

This home received an inspection in July 2013 where two areas of concerns were raised making the home non-compliant with regulations for meeting people's nutritional needs and the management of medicines.

We received an action plan in August 2013 and carried out this follow up inspection in October 2013 to see that the home had completed the actions stated in the action plan.

We found people were now supported to eat their meals appropriately and that medication was stored and administered safely.

When we carried out this inspection visit we observed people who lived at Ailwyn Hall being supported respectfully and courteously. The majority of the people at this home were living with dementia. We noted that people were regularly spoken with in a polite manner by staff, smiles were offered and the interaction was understood by the person spoken with. People were treated with respect and dignity.

The care and support offered to people was individual and informative. Risks had been assessed and action taken to minimise or remove the risks. Care plans had been reviewed monthly and with the families annually. Local medical support was regular and carried out by the same GP for continuity of medical support. People were offered the correct support to meet their care needs.

The home provided a choice of meals that was suitable for the varied needs of the people living in this home. What was not suitable was the methods used to support people properly to eat those meals that would ensure they had nutritious l meals.

The home was clean and good hygiene practices were promoted. The staff had suitable systems in place to prevent cross contamination and promote good infection control procedures.

Although some of the medication management was appropriate the administration and storage of medicines needed to be improved upon.

We used a number of different methods to help us understand the experiences of people using the service. The people who had complex needs which meant they were not all able to tell us their experiences although we were able to speak to three people who gave a positive picture of the service telling us everything was ‘good, nice and wonderful.’

One of the methods we used was an observation tool called the Short Observational Framework for Inspection (SOFI). This is a specific method used for observing care to help us understand the experience of people who cannot talk to us. We spent time observing people who use this service over a period of two hours.

This inspection took place on 16 and 23 October 2014 and was unannounced. We carried out an inspection in July 2013 where there were breaches in two regulations. A follow up inspection was carried out in October 2013 and the home had taken the appropriate action to comply with the two breaches.

Ailwyn Hall is a residential care home providing care and support for up to 39 older people living with cognitive impairments such as dementia. The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

People told us they felt safe and that staff supported them safely. Staff were aware of safeguarding people from abuse and would act accordingly. Individual risks to people were assessed and reduced or removed.

There were enough staff available. People, their relatives and staff members all said that staffing levels were high enough to allow staff members to spend time with people.

Medicines were safely stored and administered, and staff members who gave out medicines had been properly trained. Staff members received other training, although up to date records had not been maintained. Staff received supervision from the manager, which was supportive and helpful but were not frequent enough.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was meeting the requirements of DoLS. The manager recognised when people were being deprived of their liberty and was taking action to comply with the requirements of the safeguards.

Staff members understood the MCA and presumed people had the capacity to make decisions first. However, where a lack of capacity had been identified, there were no written records to guide staff about who else could make the decision or how to support the person to be able to make the decision.

People enjoyed their meals and were given choices. Drinks were readily available to ensure people were hydrated.

Health professionals in the community worked together with the home to ensure suitable health provision was in place.

All the comments we received were positive when talking about the staff team. We were told they were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated.

The home did not properly monitor care and other records to assess the risks to people and whether these were reduced as much as possible.

People’s needs were responded to well and care tasks were carried out thoroughly. Care plans contained enough information to support individual people with their needs.

A complaints procedure was available and all of the concerns and complaints made in the last 12 months had been investigated and dealt with appropriately.

People, visitors, staff members and visiting health care professionals all said that the home was well led, that the manager was supportive and approachable, and that they could speak with her at any time.