We carried out this unannounced inspection on 1 October 2018.

Bernadette House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as 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.

The service is registered to provide accommodation and residential care for up to 35 people, including older people and people living with dementia. There were 31 people living in the home at the time of our inspection.

The service can also provide personal support and care for people in their own homes. The registered manager confirmed the service covered the Lincoln city area and surrounding villages. At the time of this inspection there were no people using this part of service.

The service was run by a company who was the registered provider. The service had a registered manager in post who was available at the time of this inspection. 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. Like registered providers (‘the provider’) 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘The registered persons’.

At our last inspection on 3 March 2017 we found that improvements needed to be made to ensure that the service was consistently safe and well-led. We rated each of these parts of the service as ‘requires improvement’. Overall, our assessment of the service was ‘requires improvement’.

At this inspection we found that the improvements we had identified were needed at our last inspection had been made and that suitable arrangements had been introduced to ensure that the service was safe and being well-led. Given the progress made we revised our assessment of each of these aspects of the service to ‘good’ and also changed the overall assessment of the service to ‘good’.

However, at this inspection we found some peoples care records were not consistently effective in fully confirming all of their individual wishes and how decisions about the way their care was delivered had been agreed. The registered persons have told us about the actions they are taking in relation to this.

There were sufficient staff available and deployed in ways which helped to keep people safe and meet their care and support needs. Staff worked well together in a mutually supportive way and communicated effectively, internally and externally.

People’s medicines were managed safely and staff worked closely with local healthcare services to ensure people had access to any specialist support they required. Systems were in place to ensure effective infection prevention and control.

People were supported by staff who knew how to recognise abuse and how to respond to concerns. Risks in relation to people’s daily life were assessed and planned for to protect them from harm. There was evidence of organisational learning from significant incidents and events. Any concerns or complaints were handled effectively.

People were supported to make choices and have control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered persons had processes in place which ensured, when needed, they acted in accordance with the Mental Capacity Act 2005 (MCA). This measure is intended to ensure that people are supported to make decisions for themselves. When this is not possible the Act re

This was an unannounced inspection carried out on 3 March 2017. This was our first inspection since we registered DES Healthcare Limited on 17 July 2015 to operate the service.

Bernadette House can provide accommodation and personal care for 35 older people. There were 34 people living in the service at the time of our inspection.

The service was run by a company who was the registered provider. 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. In this report when we speak both about the company and the registered manager we refer to them as being, ‘the registered persons’.

Suitable steps had not always been taken to avoid preventable accidents and medicines were not consistently managed in the right way. Background checks on new staff had not always been correctly completed. Staff knew how to respond to any concerns that might arise so that people were kept safe from abuse and there were enough staff on duty.

Although some care staff had not received all of the training they needed, they knew how to care for people in the right way. People enjoyed their meals and were assisted to eat and drink enough. Staff ensured that people received all of the healthcare they needed.

The registered persons had ensured that whenever possible people were helped to make decisions for themselves. However, when this was not possible the registered persons had ensured that decisions were taken in people’s best interests.

The Care Quality Commission is required by law to monitor how registered persons apply the Deprivation of Liberty Safeguards under the Mental Capacity Act 2005 and to report on what we find. These safeguards protect people when they are not able to make decisions for themselves and it is necessary to deprive them of their liberty in order to keep them safe. In relation to this, the registered persons had not always ensured that people only received lawful care.

People were treated with kindness and their right to privacy was respected. Confidential information was kept private.

People had been consulted about the help they wanted to receive and they had been given all of the practical assistance they needed. They had also been supported to pursue their hobbies and positive outcomes were achieved for people who lived with dementia. Complaints had been quickly and fairly resolved.

Quality checks had not always effectively resolved problems in the running of the service. However, people had been consulted about the development of their home and the service was run in an open and inclusive way. Good team work was promoted and staff were supported to speak out if they had any concerns. In addition, people had benefited from staff acting upon good practice guidance.