About the service:

•Centenary House is a care home registered to provide personal care and accommodation to up to 13 people. The home specialises in the care of older people. At the time of the inspection 12 people lived at Centenary House.

People’s experience of using this service:

•Systems and processes to monitor the service were not effective, did not drive improvement and the provider had poor oversight. As a result, the quality of care provided to people had not improved since the last inspection.

•The service was not safe because people were not always protected against the risks associated with medicines.

•Records did not identify what people had to eat and drink each day which meant people at risk of weight loss were not monitored.

•Care records did not reflect the needs and preferences of people using the service. They were task orientated not person centred. The lack of detail meant care and support may not be given effectively.

•There was a lack of stimulation for people using the service. Several people said they would like to see improvements in this area. Very few activities were offered and those that were did not always consider individual interests, preferences or abilities.

•Some aspects of the premises were not clean. Poor infection control standards were found throughout the service. Some environmental risk had not been identified.

•We saw positive interactions during the inspection, with staff being kind, friendly and patient when assisting people.

•Staff and visiting professionals felt the registered manager was trying to make improvements with the resources available.

More information about the detailed findings can be found below.

Rating at last inspection:

•At the last inspection the service was rated Requires Improvement (December 2017). Following the last inspection, we carried out a focused inspection that was also rated Requires Improvement (June 2018). At this inspection we found the service had not improved and remains rated as requires improvement overall.

Why we inspected:

•This inspection was a scheduled inspection based on the previous rating and aimed to follow up on concerns we found in June 2018. In addition, we had received some information of concern prior to the inspection which we explored as part of this inspection.

Enforcement:

•Full information about CQCs regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

We carried out a comprehensive inspection of Centenary House on 20 and 21 December 2017.

Following this inspection we served a Warning Notice for a breach of Regulation 17 of the Health and Social Care Act 2008, Good governance.

We undertook a focused inspection on 15 May 2018 to check the provider was meeting the legal requirements for the regulation they had breached that resulted in them being served a Warning Notice. This focused inspection was to ensure the provider had taken sufficient action that ensured people were protected against the risks associated with exposure to hot radiators, hot water and the risks relating to fire doors being propped open so that they would not fully close in the event of a fire. This report only covers our findings in relation to these areas. At the last inspection ‘Well led’ was rated required improvement. This rating will not change because this was not a full comprehensive inspection. You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for ‘Centenary House’ on our website at www.cqc.org.uk

Centenary House is registered to provide personal care and accommodation to up to 13 people. The home is an older style building with accommodation for people arranged on the ground floor. The home specialises in the care of older people. At the time of the inspection there were 11 people living at the home.

There was no 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. The provider told us a new manager was due to start in post in June 2018.

During this focused inspection on 15 May 2018, we found action had been taken to ensure people were protected from the risks associated with burning themselves on hot radiators. All of the radiators in people’s bedrooms had radiator covers on them. Where there were radiators that were unable to be covered in bathrooms for example, there were risk management plans in place to prevent the radiators from becoming hot.

People were protected from the risks associated with being exposed to hot water. All of the sinks in people’s bedroom had been fitted with thermostatic mixing valves, which limited the water temperature they could reach. Regular checks of the water temperatures were being carried out by staff.

Action had been taken in relation to the risks identified by Devon and Somerset Fire Service in January 2017. People’s bedroom doors had been fitted with hold open devises to enable them to safely close in the event of a fire. We noted one door had been propped open with a cd rack as the door opener was not fully working. The provider had contacted the company that installed the devises to request they visit and ensure the devise worked appropriately.

This inspection took place on 20 and 21 December 2017, the first day of the inspection was unannounced.

We last inspected Centenary House in September 2016, during this inspection we found people’s medicines were not consistency managed safely, there was a lack of meaningful activities for people, the governance systems were not fully effective and the provider had failed to notify the Care Quality Commission of events and incidents in line with their legal responsibilities.

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 questions safe, responsive and well led to at least good. During this inspection we found that improvements had been made in some areas, however we found further concerns which resulted in breaches in the regulations.

Centenary 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.

Centenary House is registered to provide personal care and accommodation to up to 13 people. The home is an older style building with accommodation for people arranged on the ground floor. The home specialises in the care of older people. At the time of the inspection there were 12 people living at the home.

There was a manager in post and they were going through the process to apply to become the 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 were not consistently protected from the risks associated with burning themselves on hot radiators. Not all of the radiators were covered and one person had part of their bed pushed up against an uncovered radiator that was on. Water temperatures were not being tested to ensure they remained in a safe range and risks to legionella bacteria in the water systems were not being managed consistently.

Medicines were administered safely to people and people were happy with how staff administered their medicines. Some improvements were still required with medicines management. Medicines stored in the fridge were not stored securely. The fridge temperature was not taken consistently to ensure it remained within a safe range.

The home was not consistently clean, including the kitchen and there were areas of the home that needed improving. The provider had a refurbishment plan in place for the home identifying areas for improvement.

Timely action was not always taken when risks were identified in the home. Some bedroom doors were propped open which would prevent them closing and providing protection in the event of a fire in the home. This had been identified by the fire service in January 2017 and they had not all been fitted at the time of the inspection.

The systems for assessing, monitoring and improving the quality and safety of the service provided were not fully effective.

We received mixed feedback relating to the staffing levels in the home, the provider had recently agreed for another staff member to be available in the afternoons. Recruitment procedures were in place to ensure staff employed were suitable for their role.

Incidents and accidents did not occurred often in the home, when they did they were recorded by staff. When an incident had occurred any learning from it was shared with the staff team.

People felt safe at the home and with the staff who supported them. Staff were aware of the correct action to take if they suspected someone was being abused.

Staff monitored people’s health and well-being and made sure they had access to other healthcare professionals according

This inspection took place on 06 and 07 September 2016 and was unannounced.

Centenary House is registered for older people and provides care and accommodation for up to 13 people. At the time of our inspection there were 13 people using the service.

There is no registered manager in post. However the manager has made an application to be the 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.

There were failings in the administration and management of medicines. People were at risk of not receiving their medicines and some medicines had been given to people when it should have been discarded because they were out of date. There were errors in how records had been kept and changes in medicines recorded without a clear record of when and who had made the decision. This had resulted in one instance where there was unclear instructions as to the administering of medicine.

There was a lack of meaningful activities reflecting the likes and interests of people in the home. People and staff commented on how there were little or no activities. One person said "There is little to do here, I just sit all day." and another "There used to be things happening but there seems very little now."

Care planning was very task focused and did not provide staff with information about the person as an individual in respect of their life experience, relationships, interests and hobbies.

People told us they felt safe in the home. This was because as one person told us "There are always staff around when you need them." and " Staff always know what they have to do and have had the training." People could be confident staff had a good understanding of their responsibilities about reporting any concerns of possible abuse or staff practice which was potentially abusive.

There was inconsistency in how people were supported to have their meals. On occasions people were not receiving the assistance they needed to have their meals.

Staff were clear about their responsibilities in reporting any concerns about possible abuse. The manager had acted in a open and professional manner when responding to concerns which had been investigated by the local authority and found to be unsubstantiated.

Improvements had been made in the staffing arrangements in the home and this was commented on by people and staff. One person said "It is better now seem more staff around." A staff member said "It has improved dramatically." People told us how they were confident about the skills staff had and how they were very responsive to requests for assistance.

People's rights were protected because consent was sought where equipment was being used which could be viewed as restrictive such as bed rails and in one instance a stair gate positioned at the door of a person's room.

People were being cared for by staff who were seen by people as caring and kind. One person had told us "Carers treat us very kindly respecting my privacy, they talk to us nicely. You see them looking after other residents the same, we are all treated the same." Another person when asked what care workers do well replied "They treat you with respect." However we observed inconsistencies in how staff interacted with people on occasions doing so with respect and respecting people's dignity on other occasions failing to do so.

There was a welcoming environment where people could maintain important relationships. One person told us how through having regular family visitors they felt they were still in touch with what was happening. Relatives spoke of feeling able to visit at any time and felt comfortable doing so.

There were inconsistencies in how the service engaged with people. People spok

There were 11 people who use the service on the day of our visit; two care staff, the manager and a domestic member of staff were on duty. We spoke with three people who use the service and one relative, although not everyone was able to answer our questions fully. People we spoke with said “we were given information when we first arrived” and that opinions about care “are taken into consideration”. People also told us “they look after people quite well” and “they’re pretty good at doing things for you”. Staff said “it’s a friendly, happy home”.

Comments about meals included “good food”, “plenty of it” and “everything is cooked here, it’s all homemade”.

Everyone we spoke with said that staff were “very polite” and addressed them by their preferred names. We saw that staff used appropriate communication and were familiar with people’s needs.

We observed medication being administered; this was done appropriately. People that we spoke with said that they had their medications at the right times and they were administered in a way which preserved their privacy and dignity.

Most people we spoke with during the inspection felt that there were always enough staff on duty. One person said “it’s hard work for two” but agreed that they got the care they needed at a time which suited them. Another person told us they had never noticed any shortages of staff.

During this inspection we spoke with four of the eleven people who lived in the home. People told us that they were happy living at Centenary House and felt the care they received was “excellent”. One person told us, “I am really happy living here; they are like my family now. They are all really nice and the staff are excellent”.

We observed the way staff interacted with people who lived in the home. We saw that staff had a friendly relaxed rapport with people. This meant people were relaxed and felt that staff understood their needs, likes and dislikes.

We saw that people were encouraged to keep some control over the way their care was provided. For example one person still arranged all their own medical appointments whilst another person told us they were just off to the dentist.

We discussed the way infection control was managed in the home. We saw that very clear guidelines were in place and we observed staff followed appropriate procedures to prevent the spread of any infection in the home.

We looked at the administration of medication. We found that people were protected by appropriate procedures. This ensured people received the correct medication at the correct time through the day. We saw that all staff who administered medication had received appropriate training.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

This inspection was carried out to follow up on concerns identified at our last inspection, which took place 29 September 2011.

We spoke with four people who lived in the home. People told us they were very happy living at Centenary House. We asked people how they were involved in agreeing their care and the running of the home. One person told us they were really happy that they now signed their care plan. Another person however said, “I really don’t understand the need to be discussing my care and signing bits of paper. We never had to do it before.” Both people knew who their key worker was and said they spoke to them regularly. Another person spoken with said they had plenty of activities in the home and confirmed they had been asked what activities they would like to be introduced.

We spoke with seven of the eleven people living in the home. Everybody spoken with agreed that Centenary House was a homely and friendly place to live. People told us that they felt very well cared for and knew all the staff members by their first names. One person told us, "I am very happy living here it is like home from home. The staff know what I need and I never have to ask twice." Another person said, " It's very good living here I am really happy."

We also spoke with three people visiting the home. One person said, "The girls are always very nice, I am more than happy with the way my ‘relative’ is looked after. They, (their relative), have improved dramatically since they moved here." Another visitor said, "The home has a warm friendly atmosphere, which is what I like. The staff know what my ‘relative’ prefers and they are always happy to oblige." A third visitor told us, "I am really happy with the way the home is run; I don’t think big homes are as friendly. I did have to complain once about the way one of the care workers spoke. I spoke to the manager about what was said and she dealt with it immediately, I was very happy with the outcome because it was done in such a way that did not upset my relative."

During our visit we observed the way staff helped people and provided care and support. They spoke to people in a very respectful and dignified manner, whilst also keeping a friendly approach with people laughing and chatting throughout the day.

This inspection was carried out as part of our planned schedule of inspections; however we had also been contacted regarding concerns with the way some areas of the home were being managed.

This inspection took place on 26 and 27 August 2015 and was unannounced.

Centenary House is registered to provide accommodation and personal care for up to 13 older people. At the time of our inspection there were 10 people living in the home.

There was no registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 and associated Regulations about how the service is run. The home was being run by a new manager following the departure of the previous registered manager in January 2015. The current manager is in the process of applying to be the registered manager for the service.

We saw how there was not always availability of staff particularly when a person needed two care workers to provide personal care. People told us staff were at times slow to respond and staff said it would be better with more staff. There was no system to help in making a judgement about staffing arrangements.

The manager had failed to notify us of incidents which could be viewed as a person having been subject to abuse. Whilst they had notified the local authority and taken action CQC had not been given the opportunity to decide if we needed to take any action to protect people.

Since our last inspection a new manager had been appointed. Since the appointment of the new manager we were told there had been an improvement in staff morale, staff were “Working more as a team” and “People were happier and the atmosphere had improved.” People and staff told us the manager was approachable and “Someone who you can talk to” and “Approachable and supportive.” There was an environment in the home which was described by visitors and staff as “Calm and relaxed.”

The manager and provider had taken action to make improvements to the service and address failures identified in our last inspection. New arrangements and systems had been put in place when recruiting staff and in the administration and management of medicines. These new arrangements meant the service was more robust in these areas in ensuring the safety and welfare of people.

People told us they received their medicines when it was required and people where able had the choice to administer their medicines thereby retaining independence in relation to this task.

New arrangements had been put in place to assess the nutritional needs of people and have in place nutritional care plans. The service was in the process of implementing a new, more comprehensive and thorough care planning system.

People told us they felt safe with the staff “Knowing what they have to do and how to do it.” and “I feel safe with staff because they are confident and I trust them.” Staff had received the appropriate training and were able to demonstrate skills and knowledge in relation to aspects of care they provided. For example they were able to tell how they managed people who were at risk of skin breakdown or had poor skin condition, how to recognise the possibility of abuse and their responsibilities to report any concerns.

The manager and staff had a good understanding of the Mental Capacity Act and how to protect people who may lack capacity and ensure people rights were upheld.

People had access to community health services where this was required. One person told us they had requested a visit from their doctor and they were visiting that day. A healthcare professional told us the service had responded to a person changing care “We were very impressed with the care provided.”

Staff were observed supporting people in a caring and sensitive manner. People described staff as Caring and friendly.” and “All very kind and thoughtful.” However we noted how some staff referred to people as “Darling”. This could be viewed as disrespectful and people had not been asked if they were happy to be addressed in this manner.

People told how they had been involved in making a decision about the care they received. There had been some reviews by the local authority of people who were viewed as “Complex care needs”. These reviews had identified how people were receiving the appropriate care.

There was evidence through care plans, daily records and conversations with people and staff how care was responsive to people’s needs. Staff had identified changes in people’s health and made referrals for specialist advice and support.

There were systems in place for the auditing and monitoring of the quality of the service. The provider undertook visits to the service to talk with people and identify any areas of improvement. We noted that whilst there was an action plan there were no timescales set to ensure actions had been taken in a reasonable and appropriate time.

Staff had received regular one to one supervision as well as staff meeting where the manager had discussed their vision for the service and how they wanted the service to be provided. The manager told us they wanted to see a more person centred service where people received the care they needed.

We found a breach 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 this report.