This inspection was unannounced and took place on 20 and 21 September 2018.

Carrington House is a care home new to provide personal care and accommodation to up to 44 people. The home specialises in the care of older people. At the time of the inspection there were 28 people living at the home.

At the last inspection in September 2017 the service was rated overall as Requires Improvement.

Although at this inspection in September 2018, we found the provider still needed to make further improvements to the way they managed medicines, we also found evidence that previously showed the serious risks to people, had been reduced.

The provider had appointed a new manager, they had only been in post for eight weeks but clearly had a commitment to improvement. This was clear as when we raised the issues around medicine management they began to implement improvements at once. Although the new manager had submitted their application to become the registered manager of Carrington House, this had not been finalised. Therefore, in this report when we speak about the registered manager, we refer to them as being, 'the new 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.

Since the inspection the new manager has sent us further evidence showing how they have already improved the way they monitor medicines in the home, and we have recommended the provider carries out further reviews of how they manage people’s medicines. These improvements meant at this inspection we could change the overall rating to Good.

At this inspection we found that although improvements had been made, there were still some aspects of medicines management that needed further improvements and we have recommended the provider reviews how they currently manage peoples medicine and strengthen their approach. However, people did tell us they felt safe living at Carrington House and staff understood how to recognise and report signs of abuse or mistreatment.

Accident and incident reporting was robust. There were risk assessments to show any risks to the person using the service and to the staff supporting them and guidance in people’s records on what action staff should take to support people that presented with concerning behaviours. There were enough staff available to keep people safe and the provider's recruitment processes minimised the risk of unsuitable staff being employed.

People were protected by staff who followed good infection control practices. Staff were provided with PPE (personal protective equipment) such as gloves, hand gel and aprons.

The provider had systems in place to assess people’s needs and choices. Nobody we spoke with (for example people who used the service and staff) said they felt they had been subject to any discriminatory practice. People said staff had the right skills, knowledge and experience to deliver effective care and support and records showed staff received training which enabled them to carry out their roles effectively.

The provider supported people to eat and drink enough, and to maintain a balanced diet. There were several pleasant dining areas and people said the meals were nice. People also had access to quiet space and outside areas where they could entertain family and friends as well as access to daily activities that helped reduce social isolation.

Staff told us they felt supported in their roles. There were records of individual appraisals and regular supervision with a manager. Staff worked closely with external agencies and made sure people had access to health care services.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible

Carrington House is a care home registered to provide personal care and accommodation to up to 44people. The home specialises in the care of older people. At the time of the inspection there were 30 people living at the home.

At the last inspection in January 2017 the service was rated overall Requires Improvement.

At the inspection in January 2017 we found improvements were needed in a number of areas to make sure people received a safe, effective, caring, responsive and well led service. We found that medicines were not always safely managed, people were not fully protected against the risks of abuse and people were not being assessed in accordance with the Mental Capacity Act 2005. There were insufficient appropriately trained staff to meet people’s needs and the provider’s quality monitoring systems had not been effective in identifying and addressing shortfalls in the service.

Following the last inspection the provider sent us an action plan outlining how they were addressing the issues raised to improve the standard of care and support people received. At this inspection we found improvements had been made in all areas identified in the last report.

A new registered manager had been appointed who had a commitment to on-going improvement to ensure people received a good standard of care and support. 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. Whilst we acknowledge the dedication of the registered manager and staff team and the improvements made, the time period since the last inspection does not enable us to be certain that the improvements made can be sustained.

Some improvements were needed to make sure medication administration practices were fully effective in addressing people’s needs. On the first day of the inspection there were no clear guidelines in place for use of ‘as required’ medication. This meant that people who were unable to recognise the need for, or verbally express their wish, may not always receive these medicines in a consistent manner. Staff were not always pro-active in making sure people’s individual stock of medicines was sufficient to meet their needs. This had resulted in one person not having a specific prescribed medicine for four days.

The provider had systems in place, such as a robust recruitment process which helped to minimise the risks of abuse to people. Staff knew how to recognise and report any instances of abuse. All staff felt confident that any issues reported would be appropriately dealt with. People told us they would be able to speak with staff if they were unhappy with any aspect of their care. One person said, “I would speak to [registered manager’s name] or staff if I wasn’t happy.”

People received effective care because staff had the skills and experience required to meet their needs. . One person commented, “I totally trust them to do things right.” Staff monitored people’s physical health and sought advice from outside professionals to make sure they received the treatment and equipment they required.

People had their nutritional needs assessed and met. People were complimentary about the food served at the home. Comments included, “Food is good, there’s always plenty to eat” and “Very good food.”

Staff were very kind and caring and respected people’s privacy and dignity. One person said, “When they help you with getting washed and dressed they help you with little things like making sure your clothes match.” People were able to spend time in the privacy of their rooms or in communal areas. One person said, “I’m used to being on my own, I prefer it. They don’t impose but they do take me out for coffee and come and chat to me. They don’t pry.”

People were kept informed about

The inspection took place on 12 and 13 January 2017 and was unannounced. The service was last inspected on the 2 October 2013. We found no concerns at the last inspection.

The service is registered to look after 44 older people who may be living with dementia. On the days we inspected there were 36 people living at the service. The service offers residential care without nursing. Nursing care is provided by the community nursing team.

There was a registered manager employed to manage the service. 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.

People were not protected from abuse from other people living at the service. Not all staff understood how to identify abuse. There were also not enough staff with the provider’s required training to keep people safe. Staff had not received appropriate training, supervision and support to carry out their role effectively; safeguarding training was one of the topics staff were not all completing. Staff were recruited safely.

People were not always being assessed in line with the Mental Capacity Act 2005 (MCA). Where they had been completed they were not completed correctly. Applications to deprive people of their liberty had been made without completing an MCA assessment first. There was no one in the service trained to carry out assessments in line with the MCA. All staff had not received introductory training in the MCA so all staff did not understand their responsibilities under this law. This meant people’s human rights were not being respected.

Medicines were not always managed safely. Staff were administering insulin without the training and competency checks being in place. Stocks of medicine were not always recorded and one person’s medicine stock was seen to be out of date. The administration of insulin was taken over by the district nurses during the inspection. Following the inspection, the provider was ensuring a full medicines audit was undertaken.

Risk assessments were not always in place to manage people’s risks. People’s health, behaviour and risks associated with their medicine were not being risk assessed and care plans did not give staff the information required to deliver care safely. People living with dementia did not have care plans in place to meet their needs. People were not having their needs reviewed to assess whether the service could still meet their needs as they became more complex.

People’s health needs were identified but the system of making timely referrals was not operating effectively. Health professionals told us how systems to ensure staff were up to date with people’s health needs for non-urgent visits caused issues for them as they were unable to check people’s records and ensure continuity of care.

People’s records were written in a personalised way. However, people’s end of life care was not being planned with them. Treatment and escalation plans were completed by the person’s GP. No other advanced planning was in place to support people to make decisions about how they wanted to be supported by the staff at their end of life.

People had their nutritional needs met. People liked the food and the kitchen was well organised in meeting people’s dietary needs, likes and dislikes. There were systems in place to prevent cross contamination where this was required to keep people safe.

People spoke highly of how staff treated with them. People said staff treated them with respect and ensured their privacy and dignity were maintained. Staff were observed speaking with people with respect and supporting people in their own time. Staff missed the opportunity to support a person who became distressed at lunchtime. Staff were also task focused and did not res

We found that the home had established positive links with the local community. People told us they enjoyed the activities and the food at the home. One person told us they enjoyed being able to see life going on around them. One person told us that the staff were 'all that they should be'. We saw that people benefited from being connected to local events and programmes. People told us they felt listened to and were respected and involved in their care.

There were care plans and assessments in place which guided staff about people's individual needs and we found that staff were trained to carry out care safely. There was a clear process for risk management and delegation. Evidence showed that that the workforce were encouraged and supported with a mix of new and experienced staff. We saw that the wider group to which the service belonged encouraged and developed leadership qualities for senior staff.

We observed that people were relaxed and happy in the home. One person told us 'the young lady I have had several times to help me I've got to know and we have quite a laugh’.

We found that people could be confident that they received their medicines at the right time as medicines were handled safely. We saw that the staff worked closely with other agencies to ensure people's healthcare needs were met.

There were established arrangements for on-going monitoring of the quality of services and devising actions for improvement. The views of people and relatives were actively sought about what went on in the home and we found that they had significant influence on the service.

We spoke with eight people who lived in the home. They told us that staff provided the care and support they needed. People said they were very happy living at the home. They told us staff were patient and kind and that they listened to them.

People told us they chose how to spend their day. They chose what time they went to bed and what time they got up. One person said “I like to go to bed quite late and get up about eight. It’s never a problem”. Another person said “I don’t mind a bit what time I get up or go to bed. The staff always ask you if you are ready”.

People said their privacy and dignity were always respected by staff. There was a very relaxed and homely atmosphere. One person said “I love it here. The girls (meaning the female care staff) are amiable. You can have a laugh and a joke with them. They always put you first”. People were encouraged to do the things they were able to. One person told us “I can do some things for myself, but if I need help with anything I do get the help”.

People spent their time as they wished. Daily activities were arranged, as were regular trips out of the home. One person said “I have the monthly activity list here. There’s always a lot going on. You please yourself, you join in or you don’t. We have entertainers come in, bingo, card games and craft things. I like all the quizzes. We have a regular hairdresser and manicurist as well”.

People who lived in the home told us they were well cared for and that staff were available when they needed them. People said staff helped them to do the things they needed help with. Comments from people included “The staff definitely know what help I need”, “They all know what care I need, it’s all sorted out for me” and “I’m well cared for here. Your care takes priority and that’s very important”.

People told us they liked the food served in the home. People had a choice of meals each day. One person said “The food is very good. You choose on the day. There are always two choices but if you don’t like either they will always find something else you do like”.

People we spoke with said the home was a safe place for them to live. Comments included: “Oh yes, it’s definitely a safe place to live”, “I do feel safe. I don’t have to lock my door” and “It is very safe here. People can’t get in; even visitors have to ring the bell when they want to come in. There are always staff around, in the day and at night”.

People said they would raise any concerns if they had any and would be happy to share these with staff. Every person we spoke with said they were very happy with the home and had never had cause to complain. Comments from people included: “I’ve never had any concerns or complaints since I have lived here”, “I love it here, I’ve had no complaints” and “I’m 83 now and this is the ideal place for me. I’ve never had anything to complain about”.

People said they were well supported by the staff team. They said staff were available when they needed them and they understood the care and support they needed. Comments from people included “The staff are lovely”, “The staff are wonderful here. I think it’s a lovely place to live” and “The staff are very good, very knowledgeable. They all know who needs what; it’s amazing really”.

People told us they were asked to give their views on the home and that they were listened to. They talked about the meetings they had to discuss things in the home. People said that staff spoke with them every day. They said they felt able to raise any issues with any of the staff. One person said “I think the resident’s meetings are a good idea. They are a chance to bring things up and discuss them. If you can’t go you get the notes to read. It’s not only about the meetings though. Staff do ask you if you are happy with things most days”.

People we spoke with said they knew the home had records about them and that they had a plan of care. One person said “I know they have records about my care. I’m not really interested in them. It’s more important that the staff know what care I need, and they do”. Another person told us “They have a file about you and what care you need. It’s all sorted out in the office”.

People spoken with told us they liked living in the home because they felt safe and that they did not have worry about anything. People said they trusted the staff to ensure they stayed well and remained safe. One person told us they felt very secure knowing they were safe.

People told us they were happy with the facilities in the home and their bedrooms. Some said it was nice that they could have their personal belongings and furniture if they wanted. One person said their room was small but it had everything they needed. We spoke with a group of people in one of the lounges. They told us it was their favourite lounge and it was nice to meet up and chat with other people. People told us they felt the home was kept very clean and tidy. They said staff wear protective clothing when providing personal care and treatment. One person told us “it is wonderful here, everywhere is clean, my laundry gets done for me, what more could I want”. Another person told us that domestic staff were very respectful, kept their room very clean but also took care with their personal possessions.

People told us staff members were always caring, kind and respectful at all times, especially in their approach to maintaining their privacy. Most people felt they were involved in decisions about their care through staff talking to them about their care at regular reviews. Some people told us they attend regular meetings with staff and other people living in the home. They said they have the opportunity to raise concerns and contribute to how the home is run, for example, how it is decorated, ideas for the menus and ideas for activities in and out of the home.

People told us the home arranges visits with their doctor when needed. They said the home also arranges and supports them to attend appointments, such as chiropody, hospital, physiotherapy and dentistry. People said the home manages their medication for them. They said they are relieved to not have to worry about it and trust the staff to give them the correct medication. Some people said staff will talk to them about the medicines they are taking and explain any side effects.

People said they liked the food that was provided. Some people told us there was a good variety and there was always a choice of two meals each day. One person told us they enjoyed the food but would like to have different bread available. The majority of people said that their likes and dislikes are known by the chef and staff and they are always catered for.

People told us they were satisfied that their needs were being met with enough staff. People said staff were always cheerful and friendly. One person said “the staff are always busy but they always take time to chat with me”. Another person said “I can’t fault the staff they always take their time and deliver my care properly”. Two people told us they would like to get into the town more often but need help to do this. They said that staff will often get things from town for them but “it is not the same as going yourself”. People told us they felt the staff were well trained. They said staff were good at their job and knew what they were doing. People told us they often meet potential staff during the interview process. They said when the candidates are shown round the home they are often introduced to them.