We inspected the service on 14 December 2017. The inspection was unannounced. Bunkers Hill Care Home 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.

Bunkers Hill Care Home is registered to provide accommodation, nursing and personal care for 78 adults of all ages. The service can provide care for people who live with dementia, who have physical adaptive needs and/or who have special mental health needs. There were 76 people living in the service at the time of our inspection visit. The accommodation was arranged on two floors and was divided into self-contained units. Two of these that were called Bluebell and Honeysuckle were on the first floor. They were reserved for people who needed nursing care and who lived with dementia. The units on the ground floor were called Primrose and Jasmine. They were used to accommodate people who only required residential care.

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 about both the company and the registered manager we refer to them as being, ‘the registered persons’.

At the last inspection on 10 September 2015 the service was rated, ‘Good’.

At this inspection the service was rated, ‘Requires Improvement’.

We found two breaches of regulations. This was because the registered persons had not suitably assessed risks to the health and safety of people who received care and treatment. In addition, they had not done all that was reasonably practical to reduce such risks. Furthermore, the registered persons had failed to suitably assess, monitor and improve the quality and safety of the service in the carrying on of the regulated activities. This was because quality checks had had not always resulted in shortfalls in the service being quickly put right. In addition, the arrangements used to consult with people and their relatives about making improvements in the service were not robust. You can see what action we have told the registered persons to take at the end of the full version of this report.

Our other findings are as follows. Sufficient care staff had not always been deployed and some background checks had not been completed before new care staff were appointed. However, nurses and care staff knew how to keep people safe from the risk of abuse including financial mistreatment.

Suitable arrangements had not always been made to enable people to receive effective care. Nurses and care staff did not consistently use national guidelines by seeking people’s consent for the care and treatment they received. In addition, some parts of the accommodation were not designed and adapted to meet people’s needs. However, there were arrangements in place that were designed to assess people’s needs and choices so that care was provided to achieve effective outcomes. In addition, nurses and care staff had received training and in practice they knew how to provide people with the assistance they needed. This included ensuring that people had enough hydration and nutrition to maintain a balanced diet. Furthermore, there were arrangements to help people receive a coordinated care when they moved between different services and people had been supported to receive on-going healthcare assistance.

Nurses and care staff had not always been given all of the resources they needed to provide people with a service that consistently promoted their dignity. However, people were supported to

The inspection took place on 20 May 2015 and was unannounced.

Bunkers Hill is registered to provide accommodation for nursing or personal care for up to 78 older people, people living with a dementia, mental health problems, physical disability and younger adults. The home is divided in to four units to enable focussed and personalised care to people. There were 76 people living at the service on the day of our inspection.

There was a registered manager in post at the time of our 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.

The Care Quality Commission is required by law to monitor how a provider applies the Mental Capacity Act, 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way. This is usually to protect themselves or others. At the time of our inspection 17 people living at the service had their freedom lawfully restricted under a DoLS authorisation.

People felt safe and were cared for by kind and caring staff, who understood safeguarding issues and knew how to recognise and report any concerns in order to keep people safe from harm. People’s safety was maintained, because staff ensured safe ordering, administration and storage of medicines. Also, the registered provider ensured that there were always sufficient numbers of staff to keep people safe.

People were cared for by staff that were supported to undertake training to improve their knowledge and skills to perform their roles and responsibilities. People had their healthcare needs identified and were able to access healthcare professionals such as their GP or dentist. Staff knew how to access specialist professional help when needed.

People and their relatives told us that staff were kind and caring and we saw examples of good care practice. People were always treated with dignity and respect and enabled to follow their hobbies and pastimes. People were supported to make decisions about their care and treatment and maintain their independence.

There were systems in place to support people and their relatives to make comments about the service or raise concerns about the care they received. People and their families told us that the registered manager and staff were approachable.

The registered provider had systems in place to monitor the quality of the service and make improvements.

During our visit we spoke in detail with three people who lived in the home and three relatives. Some of the people who lived in the home were not able to tell us about their experience of living there so we used other ways to gather this information. For example, we looked at care records and we observed the care and support people received. We also spoke with a range of staff, the manager and the home’s care co-ordinator.

People told us they were happy living in the home and felt staff respected their decisions and wishes. They said they received a good quality of care and support which met their needs. They also told us they enjoyed a range of meaningful activities.

We spoke with the manager about the quality of some personal records in relation to signatures on care plans, medication plans, personal fire evacuation plans and end of life wishes. The manager said they would address this immediately.

We found there was enough qualified, skilled and experienced staff to meet people’s needs. Relatives told us they thought staff had the skills to meet people’s needs.

There was an effective system in place to monitor the quality of the services provided, which included seeking the views of people who lived in the home and their representatives.

We reviewed all the information we held about this provider before we visited the home. This included information from other agencies, the provider’s records, and other people who wanted to share information about the service, for example relatives. Other agencies who gave us information included the local authority.

We spoke with a number of people who used the service to gather their views about the care they received. However, some people had complex needs which meant they were not able to tell us about their experiences. Therefore we used different ways to help us understand if the care met their needs. For example, we looked at care records, we spoke with relatives, we spoke with the managers and staff who supported people, and we observed how they provided that support. We also spoke to visiting professionals, such as training assessors.

We saw people were supported to make choices and decisions about their lifestyles, and they were treated with dignity and respect.

In general we saw that people were supported by a knowledgeable care team, and they received the care and support they wanted and needed. Staff demonstrated a good understanding of their roles within the home.

People told us things like, “Its wonderful here, I get everything I want,” and “The staff are great, they really know how to help you out.”

We were unable to gain the verbal views of some people but other people spoke to us about their experiences living at the home. The people we spoke with were complimentary about the home and said they thought it was a safe place to live.

People said they were happy with the way staff cared and supported them. One relative told us, “The carers are really good, you don’t have to wait for anything, and they are very thoughtful.”

When we asked if there was anything people would like improving some said “nothing” while others said they would like more activities to take part in. We saw there was no formal programme of activities and staff said at the moment they were “ad hoc” as there was only a part time activities person. They added that a new full time co-ordinator was to start work shortly.

Most people told us they enjoyed the meals provided which they said offered variety and choice.

People said they were happy with their rooms and the general facilities offered at the home.

People told us they felt comfortable raising any concerns they might have with any of the staff and no one raised any areas of concern with us.