This inspection took place on 21 November 2018 and was unannounced. Canwick House 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. It provides accommodation for older people and those with mental health conditions or dementia. The home can accommodate up to 20 people in one adapted building. At the time of our inspection there were 18 people living in the home.

As a single provider the location did not require a registered manager. The provider was registered as 'registered person' to oversee and manage care. 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 service had previously been rated as ‘requires improvement’. At this inspection the service was rated overall as ‘requires improvement’. The service had addressed the issues raised at previous inspections and arrangements were in place to deliver a good standard of care and improve quality. However, the service has been rated as 'requires improvement' in 'well led' with repeated breaches of regulation, a breach of Health and Social Care Act (Regulated Activities) regulations 2014 regulation 17 was found. In addition a breach of Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, regulation 18 was identified. The service has not fully met some of the regulations since September 2016. We are in the process of considering further action with regard to the provider not meeting regulation. We have taken this into account when considering our rating in this domain.

There were systems, processes and practices to safeguard people from situations in which they may experience abuse including financial mistreatment. Risks to people’s safety had been assessed, monitored and managed so they were supported to stay safe while their freedom was respected. The environment was clean. There were arrangements to prevent and control infections.

Guidance and systems were in place to ensure people received their medicines when required and processes were in place to manage medicines. Where people were unable to make decisions arrangements were in place to ensure decisions were made in people's best interests. Best interests decisions were specific to the decisions which were needed to be made.

A system was in place to carry out suitable quality checks and appropriate checks had been regularly carried out and where identified actions had been taken to improve the service. The registered person had ensured that there was enough staff on duty. In addition, people told us that they received person-centred care. Sufficient background checks had been completed before new staff had been appointed according to the provider’s policy.

Staff had been supported to deliver care in line with current best practice guidance. Arrangements were in place to ensure staff received training to provide care appropriately and effectively. People were helped to eat and drink enough to maintain a balanced diet. People had access to healthcare services so that they received on-going healthcare support.

People were supported to have choice and control of their lives. Staff supported them in the least restrictive ways possible. The policies and systems in the service supported this practice.

People were treated with kindness, respect and compassion and they were given emotional support when needed. They had also been supported to express their views and be involved in making decisions about their care as far as possible. People had access to lay advocates if necessary. Confidential information was kept private.

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This inspection took place on 4 October 2017 and was unannounced. At our last inspection in September 2017 the overall rating for Canwick house was 'requires improvement' and we found they were not meeting legal requirements. We carried out a focussed inspection in February 2017 to check that they had followed their plan we found the provider was still not meeting legal requirements. At this inspection we found the provider had made some improvements but was still not meeting all legal requirements in effective.

Canwick House provides care for older people including people who are living with dementia. It provides accommodation for up to 20 people who require personal and nursing care. At the time of our inspection there were 16 people living at the home.

There was not 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.

On the day of our inspection staff interacted well with people. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe.

Medicines were administered to people safely however the provider did not have systems in place to ensure the safe management of medicines.

We saw that staff obtained people’s consent before providing care to them. Where people could not consent, assessments to ensure decisions were made in people’s best interest had not been consistently completed. This issue had been identified at our previous inspection and the provider had failed to fully address the issue. There was a breach of Regulation 11. 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’s health care needs were assessed and care planned and delivered to meet those needs. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported with their meals to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There was sufficient staff available to meet people’s needs. Staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support. People were treated with respect.

Staff were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place. Staff had received supervision and appraisals. People were provided access to social activities. They were supported to maintain relationships that were important to them.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans put in place to address any issues which were identified. However the provider had failed to identify the issues we found at this inspection. Accidents and incidents were recorded and investigated. The provider had informed us of notifications. Notifications are events which have happened in the service that the provider is required to tell us about.

We carried out an unannounced comprehensive inspection of this service on 2 September 2016. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Canwick House Care Home on our website at www.cqc.org.uk.

This inspection took place on 7 February 2017 and was unannounced. Canwick House provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 22 people who require personal and nursing care. At the time of our inspection there were 18 people living at the home.

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. However on the day of our inspection they were unavailable and the provider was unable to tell us when they would be available.

At this inspection we found that the provider had failed to ensure that previous improvements had been sustained. We found that there were breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have taken at the back of the full version of this report.

The provider did not always act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

Records were not accurate. Care plans were not updated consistently and did not reflect the care people required. Five people who were at the home for a short period of time did not have care plans or completed assessments.

Medicine records were inaccurate and not completed consistently.

This inspection took place on 7 September 2016 and was unannounced. Canwick House provides care for older people who have mental and physical health needs including people living with dementia. It provides accommodation for up to 20 people who require personal and nursing care. At the time of our inspection there were 12 people living at the home.

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.

On the day of our inspection staff interacted well with people and people were cared for safely. People and their relatives told us that they felt safe and well cared for. Staff knew how to keep people safe. The provider had systems and processes in place to keep people safe. Medicines were usually administered safely. Medication administration sheets (MARS) were completed fully. Allergies were not recorded consistently on the identification sheets in the medicine records.

The provider did not consistently act in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA provides the legal framework to assess people’s capacity to make certain decisions, at a certain time. If the location is a care home the Care Quality Commission is required by law to monitor the operation of the DoLS, and to report on what we find.

We found that people’s health care needs were assessed and care delivered to meet those needs. Care records did not always reflect the care people required. People had access to healthcare professionals such as the district nurse and GP and also specialist professionals. People had their nutritional needs assessed and were supported to eat enough to keep them healthy. People had access to drinks and snacks during the day and had choices at mealtimes. Where people had special dietary requirements we saw that these were provided for.

There were sufficient staff to meet people’s needs and staff responded in a timely and appropriate manner to people. Staff were kind and sensitive to people when they were providing support and people had their privacy and dignity considered. Staff had a good understanding of people’s needs and were provided with training on a variety of subjects to ensure that they had the skills to meet people’s needs. The provider had a training plan in place and staff had received supervision.

People were provided with access to a limited range of activities.

Staff felt able to raise concerns and issues with management. Relatives were aware of the process for raising concerns and were confident that they would be listened to. Audits were carried out and action plans put in place to address any issues which were identified, however some issues had not been identified by the audit process. Accidents and incidents were recorded. The provider had informed us of incidents as required by law. Notifications are events which have happened in the service that the provider is required to tell us about.