This inspection took place on 18 December 2018 and was unannounced. The inspection continued 19 December 2018 and was announced.

Casterbridge Manor 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.

The care home accommodates up to 64 people across two floors. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there was a cinema on the premises and a small hairdressers. There were 37 people living at the home at the time of our inspection.

At our last inspection on 8 and 11 January 2018 we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to complete an action plan to show what they would do and by when to improve the key questions, safe and well led to at least good. At this inspection we found the provider had made improvements to meet the requirements requested.

People were not always offered an effective mealtime experience. On the first day of the inspection mealtime experience was rushed with insufficient staff available to support people appropriately. Staff were task focused and did not ensure people had a positive dining experience.

We made a recommendation in regards people living with dementia dining experiences.

Professionals confirmed that improvements had been made. There was an open culture of learning from mistakes, concerns, incidents and accidents. The director told us, the previous inspection report had been disappointing and they knew they could do better. They told us this had led to “Better ways of working and investing in the service”.

Risks assessments were completed monthly using a recognised assessment tool. Where a risk was identified a plan was put in place to manage and reduce this risk. Assessments were undertaken to assess any risks to people using the service and to the staff supporting them, including people’s risk of pressure-related skin damage.

Staff had received training in safeguarding vulnerable adults, and were able to tell us how they would report and recognise signs of abuse. The registered manager told us they worked closely with local safeguarding teams to ensure people remained safe at the service. At the time of the inspection there was one open safeguarding.

People were supported by sufficient staff. The service had a suitable recruitment procedure, staff were not allowed to start work until the appropriate checks had taken place. People were supported by staff who know them well and who shared appropriate information in regards the environment, such as fire tests. People's information was stored confidentially in locked areas of the home and staff respected people’s right to confidentiality.

New staff undertook shadow shifts with more senior staff to help ensure they were competent and safe to support people. Probationary review meetings were held to check new staff members’ understanding and progress in relation to their roles and responsibilities. Staff were supported to keep their professional practice and knowledge updated.

Medicines were managed safely, securely stored, correctly recorded and only administered by staff that were trained and assessed as competent to give medicines. Stock levels were accurate with clear procedures in place for staff to follow in regards stock balances.

People described the food as good and there were systems in place to ensure people had enough to eat and drink. Where people changed their mind about what they wanted to eat they were offered alternatives. Where people needed support with fluid and food this was provided.

Although imp

This inspection took place on 8 January 2018 and was unannounced. The inspection continued on 11 January 2018 and was announced.

Casterbridge Manor 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.

The care home accommodates up to 64 people across two floors. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. Three of the bedrooms offer the option for double occupancy and all rooms have a call bell in situ. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there is a cinema on the premises and a small hairdressers. There were 32 people living at the home at the time of our inspection.

At our last inspection on 19 and 22 June 2017 we found there were not enough staff to meet people's needs in a timely manner and people were not receiving their medicines on time. Risks people faced were not always safely managed. Changes in management staff and staff roles meant that there was a lack of consistency and stability amongst staff. Management was not always effective because actions were not taken to ensure that people had consistent access to basic amenities including hot water and gas central heating.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We asked the provider to take steps to improve and ensure that they were compliant. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe and Well led to at least good. At this inspection we found that the service had made some positive changes but they were still required improvement in the key questions Safe and Well Led.

The service had a registered manager but at the time of inspection they were no longer in post. Since our inspection they have deregistered with CQC. The provider confirmed that the new manager in post would be applying to CQC to become the new registered manager for Casterbridge Manor. 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.

Risks people faced were understood by staff but there were gaps in recording and inconsistent checks that risks were managed safely.

People did not always receive their creams as prescribed. This meant that they were at increased risks of developing skin conditions. Other medicines were given as prescribed and recorded accurately.

There were some gaps in recruitment checks for some staff which meant that the provider had not been able to assure themselves of the previous conduct of applicants which meant that there was an increased risk. These risks had not been identified or actions taken to mitigate them.

Some areas of the home were not cleaned effectively. This was evident in some communal areas which meant that people were at an increased risk of the spread of infection.

Care plans were reviewed monthly but there was no consistent evidence about how people, or those important to them were involved in their care and treatment.

End of life wishes and preferences of people and their families were not consistently reflected in their care plans.

Some feedback had been sought from people, relatives and staff about the service but the systems for gathering this information were not embedded and the information had not been used to identify areas for improvements.

Audits were regular but did not consistently

This inspection took place on 19 and 22 June 2017 and was unannounced.

We last inspected this service in July 2016 but did not rate the service or any of its key areas on that occasion. The home had registered and started to provide a service on 13 January 2016. We use the phrase 'inspected but not rated' where a service is new, or where we do not have the evidence to apply a rating (for example it is a 40 bedded care home that has recently opened but only eight people are living there at the time of the inspection).

Casterbridge Manor provides accommodation and nursing and personal care for up to 64 people. There were 28 vacancies at the time of inspection. The service is located in Cerne Abbas and is a large building with rooms arranged over two floors and a central ground floor lounge and dining area. Three of the bedrooms offer the option for double occupancy and all rooms have a call bell in situ. There are two staircases to access the first floor and a passenger lift. People are able to access secure courtyard gardens within the home and there is a cinema on the premises and a small hairdressers which is also open to the local community.

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.

There were not enough staff to meet people’s needs in a timely manner. People told us about how this affected them and staff explained why they felt they needed additional staffing.

Staff understood the risks people faced but these were not consistently monitored or effectively managed.

Medicines were not consistently received on time and on both days of our inspection people were still receiving their morning medicines at 11:30.

The service was not always effectively managed because actions were not taken to ensure that people had consistent access to basic amenities including hot water and gas central heating.

There had been several changes to the senior staff at the service and changes in staffing and staff roles meant that there was a lack of consistency and stability amongst staff.

People were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

Staff were aware of the risks people faced and understood their role in reducing these. People had individual risk assessments which identified risks and actions required by staff to ensure that people were supported safely.

People were supported by staff who had been recruited safely with appropriate pre-employment, reference and identity checks.

People had access to a range of health services when these were needed.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas and refresher sessions were booked for certain topics on a regular basis.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation. Where people had decisions made in their best interests, these included the views of those important to the person and considered whether options were the least restrictive.

People spoke positively about the food and had choices about what they ate and drank. The kitchen were aware about people’s dietary needs and where people required a special diet or assistance to be able to eat and drink safely this was in place.

Staff knew people well and interactions were relaxed and caring. People were comfortable with staff and we observed people being supported in a respectfu

The inspection took place on 11 and 13 July 2016 and was unannounced.

We have not rated this service or any of its key areas on this occasion. We use the phrase ‘inspected but not rated’ where a service is new, or where we do not have the evidence to apply a rating (for example it is a 40 bedded care home that has recently opened but only eight people are living there at the time of the inspection).

The service is registered to accommodate a maximum of 64 people, however only 25 people were living there at the time of the inspection.

Casterbridge Manor is a Nursing and Residential care home in Cerne Abbas. It registered and started to provide a service on 13 January 2016. The home is a large building with rooms arranged over two floors and around a central ground floor lounge and dining area. There are 61 bedrooms, with three of these offering double occupancy. All bedrooms have a call bell in situ. There are two staircases to access the first floor and a passenger list. People are able to access secure courtyard garens within the home and there is a cinema on the premises which people can access.

The service had a registered 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.

People sometimes had to wait for extended periods for support. People told us that there were not enough staff at the service and we observed that Call bells were not always answered quickly. Call bells were also very quiet and we observed that there were areas of the home where bells could not be heard.

People had assessments in place to support some of their identified risks. However, there were some risks which people faced where there were no risk assessments in place to advise about how to support the person and manage the risk.

The service was not always secure. People could access the building as there were no secure doors between the staff entrance and the main ground floor of the home.

The service was not always working within the principles of the Mental Capacity Act(MCA). Information was sometimes conflicting and consent forms did not follow the principles of MCA. . This meant that the service was not always doing all that was possible to seek consent from people and make appropriate decisions in the persons best interests.

People told us that they were not always able to communicate well with staff as some had poor English skills. The registered manager told us that they had brought in an English teacher to support staff and some staff were now signed up for local English courses.

Staff did not all have the necessary skills and knowledge to support people and told us that there were gaps in training. We saw that staff received training in a range of areas and refreshers for certain topics were booked in for staff, however there were gaps in staff understanding for some topic areas and these had not been picked up or further development options offered.

Meetings for people, relatives and staff were held regularly and discussions and suggestions welcomed. However there were no clear action plans to ensure that any issues or suggestions made were followed up.

People and staff had mixed views about how well the service was managed and some people felt that they did not see them very often. The deputy manager had left very recently and we observed that the registered manager was extremely busy with a range of tasks.

People told us that they felt safe at the service and relatives agreed with this view. We observed staff supporting people safely. Staff received training in how to protect people from abuse and were able to explain the possible signs of abuse and how to report these.

Recruitment records we looked at showed that appropriate