The inspection took place on the 5, 6 and 16 February 2018 and was unannounced.

Callands care home was previously inspected in March 2017. During the inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that the registered person had failed to ensure that people consistently received safe care and treatment and the management of medicines was not completely safe.

Furthermore, we found that the registered person had failed to ensure that sufficient numbers of suitably qualified, competent, skilled and experienced persons were not being deployed effectively and effective systems were not in place to assess, monitor and improve the quality and safety of the service.

At this inspection we found that the registered provider had taken action to address breaches identified at the last inspection.

However, during our inspection, we found further breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 related to good governance and the need for consent.

We found that accurate, complete and contemporaneous records were not always being maintained in respect of each service user. Furthermore, we found that the registered person had not always acted in accordance with the principles of the Mental Capacity Act. You can see what action we told the provider to take at the back of the full version of this report.

Callands care home is a 'care home' run by HC-One Ltd. 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.

The care home is a two storey building that accommodates up to 120 people across five separate units, each of which have individual lounges and dining areas with adapted facilities. The units include: Coniston (which accommodates 30 older people with nursing care needs); Windermere (for 10 people living with dementia); Grasmere (for 30 people living with dementia who also have nursing needs); Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults). At the time of our inspection, the service was accommodating 100 older people with a diverse range of needs.

Callands care home is set in its own grounds within the Callands area of Warrington. A range of shops and other local facilities are within walking distance of the care home and the area is supported by good public transport services. There is a car park provided for visitors at the front of the building.

The care home did not have a registered manager 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.

During our three day inspection, we spoke with people living in the care home, relatives and staff. We also undertook observations of the standard of care provided. We saw that staff took time to talk and interact with people throughout the day and were helpful and supportive when people asked for help. We also noted that staff interactions were positive and that people living in the care home had access to activities and were treated with respect and dignity.

People had access to a range of health care professionals to help maintain their health and wellbeing and medication was ordered, stored, administered, recorded and disposed of safely. People using the service were also provided with a range of wholesome and nutritious meals and alternative and vegetarian choices were available upon request.

Staff had access to induction, mandatory and service specific training to help them understand their roles and responsibilities.

Systems had

This inspection was unannounced and took place on the 10 March 2017. A second day of the inspection took place on 13 March 2017 in order to gather additional information.

Callands Care Home was previously inspected in March 2016 when it was found to be meeting all the regulatory requirements which were inspected at that time. We also undertook a focussed inspection on the 20th July 2016 to review action taken since our last inspection and to check that people were receiving appropriate care and support as we had received information of concern. During that inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and safe care and treatment. We found that people using the service had not always had their needs adequately assessed and planned for. Furthermore we found that people did not always receive care that was person centred and responsive to their needs.

During this inspection we found that the provider had taken action to address one of the breaches identified at the last inspection in respect of person centred care. We found that improvements had been made in regard to the breaches however further work was needed in both areas.

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our inspection the service was accommodating 110 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

The units include: Coniston (which accommodates 30 older people with nursing care needs); Windermere (for 10 people living with dementia); Grasmere (for 30 people living with dementia who also have nursing needs); Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was no registered manager at Callands Care 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.

The deputy manager had been assigned to oversee the management of Callands Care Home pending a newly appointed manager commencing in post and was present during the two days of the inspection.

Whilst many of the people spoken with and their representatives told us that they were well cared for and happy in Callands Care Home, we observed and identified breaches of the relevant regulations in respect of staffing, safe care and treatment, person centred care and good governance. You can see what action we told the provider to take at the back of the full version of the report.

Systems were in place to safeguard people from abuse and to respond to complaints. Staff spoken with confirmed they had received training in this key area and were confident that any allegations of abuse made would be reported and fully investigated to safeguard people’s welfare.

Some people who used the service did not have the ability to make decisions about some parts of their care and support. There were systems in place to protect people who could not make decisions which followed the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). Staff also had access to training in this protective legislation.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were had access to induction, regular on-going training and periodic supervision to develop the necessary skills and competence for their rol

We carried out an unannounced comprehensive inspection of Callands Care Home on the 7th, 8th and 17th March 2016. Following our inspection we recommended that the activities programme and staffing resources be reviewed to develop and enhance the provision and range of activities on offer for people using the service.

This was because a number of people highlighted concerns regarding the range of activities available in the home. People told us that they felt there were insufficient activities on offer to meet their diverse needs and the number of people living in the home.

Since our last inspection in March 2016, we have received information of concern regarding the standard of care provided to people with complex support needs.

We therefore undertook a focussed inspection on the 20th July 2016 to review action taken since our last inspection and to check that people were receiving appropriate care and support.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Callands Care home’ on our website at www.cqc.org.uk

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our focussed inspection the service was accommodating 114 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

The units include: Coniston (which accommodates 30 older people with nursing care needs), Windermere (for 10 people living with dementia), Grasmere (for 30 people living with dementia who also have nursing needs), Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was no registered manager at Callands Care 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.

A peripatetic manager had been assigned to oversee the management of Callands Care Home and was present during the day of the inspection. We were informed that a new manager had been appointed and that this person intended to apply to register with CQC.

During this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report. We found that people had not always received care that was person centred and responsive to their individual needs and that some call bells were not operating and / or being responded to effectively.

Since our last inspection the provider had increased activity coordinator hours by ten additional hours per week to enable the provision of activities over a seven day period. A sensory garden had also been developed for the Grasmere unit to include an arbour area and sensory items and a newsletter produced. Despite this action, people spoken with were still of the view that the range of activities on offer was limited and that this issue remained in need of review.

Systems were in place to record and respond to complaints.

This inspection was unannounced and took place on the 07 March 2016. A second and third day of the inspection took place on 08 and 17 March 2016 in order to gather additional information.

Callands Care Home was previously inspected in April 2014 when it was found to be meeting all the regulatory requirements which were inspected at that time.

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. At the time of our inspection the service was accommodating 105 people.

The home is a two storey building which has five units equipped with individual lounges and dining areas set in its own grounds within the Callands area of Warrington. There is a car park provided for visitors at the front of the home.

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The units include: Coniston (which accommodates 30 older people with nursing care needs), Windermere (for 10 people living with dementia), Grasmere (for 30 people living with dementia who also have nursing needs), Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was a registered manager at Callands Care 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.

The registered manager was not in day to day charge of the service when we inspected Callands Care Home. A peripatetic manager had been assigned to oversee the management of Callands Care Home and was present during the three days of the inspection.

During the inspection we found Callands Care Home to have a pleasant and homely atmosphere. We observed people's choices and preferred routines were respected and that staff communicated and engaged with people in a compassionate and caring manner.

Staff recruitment systems were in place and information about prospective employees had been obtained to make sure staff did not pose a risk to people using the service.

Staff were supported through induction, regular on-going training and supervision to develop the necessary skills and competence for their roles.

Medicines were ordered, stored, administered and disposed of safely.

People using the service had access to a choice of menu. The provider’s hospitality manager was due to visit the home to undertake a review of catering and people’s dining experience in order to improve standards following feedback received from people using the service.

Records showed that people also had access to GPs, chiropodists and other health care professionals (subject to individual need).

Corporate policies were in place relating to the MCA (Mental Capacity Act (2005) and DoLS (Deprivation of Liberty Safeguards). Staff understood their duty of care in relation to this protective legislation.

Systems were in place to safeguard people from abuse and to respond to complaints.

People spoken with highlighted concern regarding the range of activities available in the home and felt that there were insufficient on offer to meet their diverse needs and the number of people living at Callands Care Home. We have made a recommendation relating to this matter.

We did not speak to people using the service as part of this follow up inspection. The views of people using the service were obtained during our last inspection which was undertaken on 5th August 2013.

We spoke with management and staff and reviewed a sample of records which included staffing rotas, dependency tools and care plan documentation as part of this follow up inspection. Records viewed contained evidence that systems were in place to monitor the changing needs of people using the service and for the effective deployment of staff.

People spoken with reported that they were generally satisfied with the standard of care and treatment provided at Callands Care Home and confirmed they were supported in a caring and dignified manner.

People using the service and their representatives reported that they were happy with the standard of care provided. They gave overall positive comments about their support and made various comments such as: “It couldn’t be any better here. I’m not one for company. I like to stay in my own room. I suppose I could go to activities if I wanted”; “Nothing bothers me”; “I’m very happy. I have no complaints”; “I‘d like to raise some things with staff but we’ve not had any meetings recently. I’m not sure if I have a keyworker but if I did have one I’d like to always be able to talk to them.”

Likewise, relatives were positive about the service and made various comments such as: “We are very happy. Our relative doesn’t like to get involved in activities but the staff always give personalised care, especially for meals”; “My sister looks better and the rest is doing her good” and “I’m happy with the care. I can visit any time and make myself a cup of tea and have a biscuit or have a drink at the bar. You are always made to feel welcome.”

People spoken with confirmed they received their medication correctly and at the right times.

People spoken with reported that they were generally satisfied with the standard of care and treatment provided at Callands Care Home and confirmed they were given appropriate information and support regarding their care or treatment. Comments included: : “It’s not a bad place to live”; “I like it here and the staff are helpful and caring people” and “My family received information on the home before I moved in.”

People informed us they felt safe living at Callands Care Home and were observed to be relaxed in their home environment and in the company of the staff team. For example, comments received included: “I can’t fault the care I receive”; “The carers look after me” and “I’m happy with everything and the standard of care is fine.”

Callands Care Home is owned by HC-One Ltd (the provider) and provides personal and nursing care for a maximum of 120 people. It is a two storey building which has five units – Coniston (which accommodates 30 older people with nursing care needs), Windermere (for 10 people living with dementia), Grasmere (for 30 people living with dementia who also have nursing needs), Ullswater (for 20 people with nursing care needs) and Lakeside (for 10 older people and 20 younger adults).

At the time of our inspection there was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

We found that most people who lived in the home and all the relatives we spoke with thought the care at Callands Care Home was good. We saw that on the units providing care for people living with dementia that staff interacted well with the people who used the service. We found the home was well-managed and the new registered manager was implementing a number of programmes for improvement including staff supervision and developing the environment for people living with dementia.

We found that whilst opportunities existed for people to influence their care, they were not always aware of the means of doing this through key worker systems or influencing care plans. We found that record-keeping was inconsistent particularly around assessment of mental capacity.  Although the home had followed the correct procedures for people who required Deprivation of Liberty Safeguards with respect to the authorising authority, they had not made the relevant notification to CQC.