About the service:

Chester Lodge is a residential care home that provides personal and nursing care for up to 40 people. Some people also live with dementia. At the time of the inspection 33 people lived in the service.

What life is like for people using this service:

Whilst improvements had been made, we identified a continued breach of regulation in relation to records.

The registered providers system for checking on the quality and safety of the service were not fully effective as they did not identify risks associated with people’s safety and a lack of records. Hot water outlets were not checked at the required intervals to make sure the water temperature was at a safe level for people to use. Records were not completed with details of fire drills carried out and the fire risk assessment for the environment was out of date. Although the registered provider had safe recruitment procedure, it was not followed for a senior member of staff. Care records for some people did not fully reflect their assessed needs and how they were to be met. Records for monitoring aspects of people’s care did not include information about their needs and had not been consistently completed to evidence the care they were given. Monitoring records had not been evaluated at the end of each day as required. The manager took prompt action during the inspection to make the improvements.

The management of medication had improved since the last inspection. Medication was safety stored and medication administration records (MARs) were kept up to date. People received their medicines safely and on time.

People who were able consented to their care and support. Decisions made on behalf of people who lacked capacity to make their own decisions were made in line with the Mental Capacity Act. These decisions had been better recorded since the last inspection.

People were protected from abuse and the risk of abuse because staff understood their role and responsibilities for keeping people safe from harm. People told us they felt safe and family members were confident that their relative was kept safe. The premises were kept clean and hygienic and staff followed good infection control practices to minimise the spread of infection. People’s needs were met by the right amount of suitably skilled staff.

People told us they received all the right care and support from staff who were well trained and competent at what they did. People received the right care and support to maintain good nutrition and hydration and their healthcare needs were understood and met.

People were treated with kindness, compassion and respect. People told us that staff were kind and respectful of their privacy and dignity and encouraged their independence. Staff had formed positive relationships with people and their family members. Visitors people received were made to feel welcome.

People received personalised care and support. People, family members and others knew how to make a complaint and they were confident about complaining should they need to. They were confident that their complaint would be listened to and acted upon quickly.

The leadership of the service promoted a positive culture that was person centred and inclusive. People, family members and staff were confident in the management of the service. They described the manager as supportive and approachable. They told us many improvements had been made to the service since the last inspection and that they were fully engaged and involved in the running and development of the service. The manager and staff worked in partnership with others in the best interest of people using the service.

More information is in Detailed Findings below

Rating at last inspection: Requires Improvement (report published 08 August 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We saw improvements had been made since our last inspection, however further improvements where

This inspection took place on the 26 and 28 June 2018 and the first day was unannounced.

At the last inspection we found multiple repeated breaches of legal requirements in regards to safe care and treatment, nutrition and hydration, dignity in care, record keeping and overall governance.

Following the last inspection, we asked the registered provider to confirm what they would do and by when to improve its rating from Inadequate to Good.

On this inspection we found that a number of improvements had been made but further work was required to ensure full and sustained compliance with the regulations.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Chester Lodge is ‘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 40 people in one purpose built building which is spread over 3 floors. At the time of the inspection 24 people were living at the service.

The registered manager had been absent from the service since April 2018 and we were informed that they were unlikely to return . A registered 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. In the interim period, the Clinical Lead Nurse had taken on the manager role.

The quality assurance systems in place had been reviewed and the registered provider now acknowledged that it previous monitoring of the quality and safety of care had been ineffective. They had made use of external consultants as well as commissioners to assist them in identifying shortfalls and making improvements. People and staff confirmed that the registered provider had been open and honest with them about the issues regarding the service and what they intended to do to put things right.

People received their medication as prescribed. However, topical medication was not always stored in a safe and secure way. An accurate record was not kept of its application nor that of prescribed thickener. Risk assessments were not always in place where medication posed a specific risk to a person’s health and wellbeing such as from fire or excessive bleeding.

New staff employed at the service had an induction and worked with more experienced staff to ensure they were confident and had the required skills. Recruitment checks had been undertaken prior to employment but references were not always taken from the last employer. This meant that there was no assurance in place of a person’s suitability for the post. We made a recommendation in regards to this.

Accident and incidents were effectively monitored. Review of these included identifying causation, on-going risk and trends. Steps were taken to reduce the reoccurrence of accidents and there was evidence of their effectiveness. Risk management plans did not fully outline for staff what was required to keep a person safe.

Care plans were being reviewed in order to record people's needs accurately but some improvements were still required to ensure they were complete and accurate. Records were better personalised to reflect pe

This inspection was carried out on 18 and 27 September 2017. Both visits to the service were unannounced. Chester Lodge care home is a privately owned service providing residential and nursing care for up to 40 people. It is located close to Chester city centre. At the time of our inspection there were 35 people living at the home.

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.

At the last inspection December 2016, we asked the provider to take action to make improvements in regards to safe care and treatment, capacity and consent and overall governance. These actions had not been completed.

During our visit we found a number of new and repeated breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People we spoke with said that they felt safe at the home and relatives felt that staff did their outmost to support people and protect them from harm. However, we found that the risks to people’s health and safety were not always identified, assessed or managed.

There was a safeguarding concern prior to the inspection in relation to the management and assessment of pressure ulcers. Care plans did not always include accurate information for the prevention and management of pressure ulcers.

A number of people were at risk of malnutrition or dehydration. However, food and fluid charts were not always completed in detail to reflect what people had eaten and drunk over a 24 period and to inform assessment of the person’s nutritional status.

Referrals to health professionals were made when concerns regarding people’s health were identified, but this was not always done in a timely manner. We found that advice and guidance provided by health professionals was not always implemented to ensure that risks to people’s health and wellbeing were minimised

People did not always receive their medication as prescribed as there were delays in administration. Medication was not always stored in a safe and secure way.

Accident and incidents were not effectively monitored. Review of these did not always identify causation, risk or patterns. Management plans to reduce the occurrence of accidents were not always followed or their effectiveness reviewed.

Some call bells were out of reach and inaccessible. When people were unable to use a call bell, robust plans had been put in place to ensure the person received the attention they needed.

The premises were not clean and we detected unpleasant smells in parts of the building. The management of infection control required improvement .

Staff showed limited understanding of their responsibilities in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Supporting documentation did not reflect how specific decisions for people who may lack capacity had been made in their best interest. Decisions were made by people without any legal delegation to do so. However, staff practice showed that people’s consent was considered before care or support was provided.

Staff did not always respect people’s opinions and choices in regards to how they wanted their support to be provided. People were not always kept comfortable and were not always treated with dignity and respect. People informed us that the staff were caring and did the best that they could to look after them.

Care plans did not always record people’s needs accurately. Records were not personalised to reflect people’s individual preferences about how they would like their care and support to be provided.

The quality assurance sys

We carried out an unannounced comprehensive inspection of Chester Lodge on 14th December 2016.

During a focussed inspection of the service on17th August 2016, the service was rated as inadequate. This visit took place to assess any improvements that had been made in response to this change of rating.

Chester Lodge is a nursing home that is owned by Heathbrock Limited. It is a modern three-storey building close to Chester city centre. There is car parking space next to the building. The home provides personal and nursing care for up to 40 people. Thirty people were living at Chester Lodge at the time of our visit.

A registered manager was in place and was present during our visit. 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 last inspection of the service in August 2016 had focused on how safe and well led the service was. We found during that inspection that there were a number of breaches of regulations which meant that people were not safe from risks of harm and did not receive care from a well led service.

The registered provider was served with a Notice of Decision in August 2016. This meant that a condition had been placed on the registered provider in respect of restricting admissions. This meant that all proposed admissions need to be agreed by CQC prior to admission. This is still in place.

These breaches included a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because people who lived at Chester Lodge did not always receive safe care and treatment.

On this inspection, although we found some improvements had been made, we found repeated breaches of regulation 11 and regulation 17.

Staff understood the principles of the Mental Capacity Act and applications had been made by the registered provider to the Local Authority for authorisations to carry out such restrictions and safeguards. .Evidence of best interest meetings and how consent was gained from people lacking capacity was not present. This was a repeated breach of regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 gaining consent.

Our last visit showed that care plans were not personal to the needs of the people who used the service. Care plans were available for all people. Evaluations were brief and did not include how care plans had been evaluated and who had been involved in this process. In care plans we looked at, evaluations included the outcome and care plans changed as a result. Care plans were still not person centred. This was a repeated breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Our last visit noted that there were deficiencies in the auditing process and the reporting of adverse incidents to CQC. This has resulted in a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) regulation s 2014. Improvements had been made to audits of falls and associated actions. While notifications to CQC had improved, there had been a significant delay in notifying CQC of one allegation of abuse incident since our last visit in August 2016.

We also found that some of the audits did not identify the issues raised at this inspection in particular lack of personalised care plans as well as the lack of robust evaluation of care plans. These were issues we raised at the last inspection but have not been actioned.

This visit confirmed that some improvements had been made to ensure the safety of people who used the service. However, we observed one person being given a drink without the thickener that had been prescribed to them. This meant that they did not receive safe care and trea

We carried out an unannounced focussed inspection of Chester Lodge on 17th of August 2016.

This visit took place in response to concerns that we had received. These concerns included concerns about the safety of people who used the service as well as the way in which the service was led.

During this visit, we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. We will publish the actions we have taken at a later date.

Chester Lodge is a nursing home that is owned by Heathbrock Limited. It is a modern three-storey building close to Chester city centre. There are car parking spaces next to the building. The service provides personal and nursing care for up to 40 people. At the time of the inspection there were 34 people using the service.

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. The registered manager was not present during our visit.

A comprehensive inspection had taken place at the service in June 2016. At that inspection we found that the registered provider was required to make improvements in all the five key areas that we looked at. The inspection in June 2016 highlighted that there were breaches of regulations 11 and 17. Regulation 11 related to the need for consent to be gained from people in respect of their care. Regulation 17 related to the lack of a care planning in respect of medicines prescribed when needed and the need for person-centred and comprehensive care plans.

On this visit we found that the premises were not safely secured which meant that people who used the service could not have their safety guaranteed at all times. Visitors to the service were not monitored therefore staff had no way of knowing who was in the building, Fire doors were not always closed as required which meant that should a fire occur it could not be contained in one area. Cleaning products hazardous to people’s health were left unsecured in a sluice room which in turn was not locked when not in use. An area designated for staff use only was not secured and contained hazards to people who used the service.

We observed people who used bedrails did not always have their safety and comfort taken into consideration despite this being identified as an issue during our last visit in June 2016.

Sections of care plans designed to take the safety of people in to account were out of date. No falls risk assessments were in place for people when there was evidence that they had experienced numerous falls in a short period of time.

Call alarms were responded to inconsistently. We timed the response to call alarms and found that the response times varied. For example some were responded to promptly and others exceeded 20 minutes. Some people stated that their calls were responded to quickly, however one person told us staff had taken some time to answer their calls or had not responded at all.

Staff demonstrated a limited understanding of the process for reporting any abuse allegations. Staff either had no understanding of whistleblowing or did not have the confidence to raise concerns whilst in employment at the service.

Medication was secure; however, a refrigerator used for the storage of some medications was not secure when not in use.

The registered manager had failed to notify us of many incidents that adversely affected the health of people who used the service. Audits undertaken in respect of falls and medication were not robust. Audits had not been undertaken in respect of many key areas such as care plans, bedrail risk and call alarms.

The registered provider was not able to produce a complaints procedure on request or a supporting record of com

This inspection was carried out on 1 June 2016 and was unannounced.

Chester Lodge Care Home is a privately owned residential and nursing care service located close to Chester city centre. The service is based over three floors, which provide accommodation and personal care for up to 40 people. Access to the upper floor is via a passenger lift or stairs. Local shops and other amenities are a short distance away from the service. At the time of our inspection there were 35 people living at the service.

There was a registered manager that had oversight of the whole 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. At the time of our visit the registered manager had been away from the service for some time and the deputy manager was responsible for the day to day running of the service.

At the last inspection on 29 October and 3 November 2015 we found that a number of improvements were needed in relation people not being protected from the risk of unsafe care and treatment and poor management of infection control. People were not always supported or treated in a dignified way and consent to care and treatment was not always sought. People were not protected from the risk of inadequate nutrition and hydration and quality assurance systems were not effective. We asked the registered provider to take action to address these areas. The service was placed into special measures by CQC.

After the inspection, the registered provider wrote to us to say what they would do to meet legal requirements in relation to the breaches identified. They informed us they would meet all the relevant legal requirements by the end of January 2016. This inspection found that there was enough improvement to take the provider out of special measures. Whilst we found a number of improvements in most areas, the registered provider had not demonstrated full compliance with the Health and Social care Act 2008 (regulated activities) 2014. You can see what action we have told the provider to take at the end of this report.

People received their medication as prescribed and the deputy manager had completed competency assessments in the safe administration and management of medication with all nursing staff. Medication administration records (MAR) were appropriately signed and coded when medication was given. Care plans relating to PRN (as required) medication were not in place to guide staff. There was no clear written guidance for staff to follow to establish when and how PRN medication would be required to be given.

Staff had an understanding and awareness of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). People confirmed and observations showed that staff always asked for consent prior to providing care and support. The registered provider had submitted DoLS applications to the local authority where appropriate. However, people’s care records contained limited information about their mental capacity, and mental capacity assessments and best interests decisions had not been completed as required by the MCA.

The registered provider had introduced a number of quality assurance audits since our last inspection visit. Further improvements were needed to make sure that they were effectively used by staff to evidence what actions had been taken to ensure the quality and safety of the care provided to people. CQC were notified as required about incidents and events which had occurred at the service. We have made a recommendation about the effective use of audits.

Staff were able to describe the care and support people required. Daily records were completed in good detail to reflect what care and

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

We visited this service on 28 July 2014 and the inspection was unannounced.

The last scheduled inspection was carried out in September 2013 and we found that the home was not meeting the required regulations with regard to the safety and suitability of the premises. We revisited the home on 17 March 2014 and found that actions had been taken and the home now met the current regulations.

Chester Lodge is a nursing home that is owned by Heathbrock Limited. It is a modern three storey building close to Chester city centre. There are car parking spaces next to the building. The home provides personal and nursing care for up to 40 people.

At the time of our visit there were 34 people living at the home.

The registered manager was experienced and had worked at the home for many years. She had been the registered manager for five years. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People told us that they were happy living at the home and they felt that the staff understood their care needs. People commented “The staff are kind”, “I like it here”, “Mum is safe here” and “This is the best place I have been in.”

We found that people, where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

We found the home was clean, hygienic and well maintained in all areas seen.

Records showed that CQC had been notified, as required by law, of all the incidents in the home that could affect the health, safety and welfare of people.

We looked at the care records of four people who lived at the home. We found there was detailed information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were completed and up to date.

We found the home had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the home had policies and procedures in place to guide staff in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), safeguarding and staff recruitment. This meant that staff had documents available to them to help them understand the risk of potential harm or abuse of people who lived at Chester Lodge.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. This meant that the people who lived at Chester Lodge could be confident that they were protected from staff who were known to be unsuitable.

Following the compliance action made during the planned review on 16 September 2013 the provider sent an action plan which showed how and when the service would be compliant with the regulation for safety and suitability of the premises.

We visited Chester Lodge and undertook a tour of the building, spoke with four people who lived at the home, two staff, the registered manager and owner.

People who lived at Chester lodge confirmed they were happy with their bedrooms and the environment in general. They all agreed the home was clean and odour free. Other comments included: “I am very happy with my room”, “I have no problems or concerns”, “My room is lovely” and “The staff work very hard and are good.”

Staff commented: “This is a lovely home”, “I enjoy working here” and “The atmosphere here is lovely.”

During a tour of the building we found it clean and odour free and improvements had been made since our last visit.

We looked at three care plan records and they all had an assessment of their health and social needs completed. These were up to date and reviewed on a monthly basis.

We spoke with four people who used the service, four relatives, three staff and two professionals involved in the service. People who used the service said: “The staff are nice” and “I am well looked after here.”

Relatives commented: “The home is clean and odour free”, “I am delighted with the home” and “The staff treat my relative extremely well.”

Staff commented: “The staff work well as a team”, “The training is good”, “The staff help each other out” and “I like caring for the people here and sitting and chatting to them.” All the staff said they got good support from the management team.

Other professionals said: “The home is very nice”, “The staff are great with the residents” and “We have a good working relationship.” They both said that they had no issues or concerns with the service.

We looked at the rotas and staffing levels at the home and discussed staffing issues with the manager.

We observed interactions between the people who used the service and staff during the day and found there was a relaxed and friendly atmosphere between them.

During a tour of the building we found it was clean and odour free. However concerns were raised regarding some stained carpets, a rip in the corridor carpet, some bedroom furniture and some documentation regarding the home.

We spoke with eight people who used the service who confirmed they had been involved in the care planning process. We found that people were supported to be as independent as possible. Staff discussions confirmed that people's dignity and independence was promoted and they were treated with respect. Comments from people who lived at Chester Lodge included "The staff are very kind and nice here", "I like my room" and "The staff are good and I am comfortable here. " All the people we spoke with confirmed they felt safe in the home and were happy with the support they received.

We looked at three care records and all these were up to date and reviewed regularly. This meant that the service could demonstrate they could meet people's needs and maintain their health and well being.

We found the provider had robust and effective recruitment procedures in place. We spoke with four staff members. They said "It is a good, friendly staff team here", "The training is good", "The manager will organise other training if you ask", "The manager is highly thought of and is committed totally to the residents here" and "The provider is brilliant and helpful". We spoke with one relative and a GP, commented "The home is clean and doesn't have any odours. I don't have any problems or concerns", "My relative has improved in health since they have been here. The staff are friendly and if I had any concerns I would contact the manager." During our visit the home was clean and odour free.

We spoke to people who use the service and they said:

“It is okay here. I enjoy the meals”

“The staff are very good. The food is good but sometimes it is too much for me, there are always choices available. The care is good”

“The staff are very kind.”

We spoke with relatives of the people who use the service and they commented:

“We are very happy with the care and support our relative receives”

A relative wrote to us and said “We chose Chester Lodge as it had a good reputation. The staff have kind and caring attitudes to all the residents. Nothing is too much trouble for the staff. My Mother is truly content at the home and we feel confident that the staff are caring and capable of meeting any need she may have. I would happily recommend Chester Lodge to any family or individual looking for a suitable home for a much loved older family member.”

We spoke with staff and they commented:

“I have worked here for 18 months. The staff are a good team. The manager is very good at her job. I like working here”

“I have been here 2 years. The manager has turned the home around and is a very good manager. The staff team is good and supportive to each other”

“I enjoy coming to work. The staff are a really good team. Staff come into the home on their days off to support activities in the home. The ethos in the home has changed since the manager took over and staff and relatives want to be actively involved in the home”

“I feel listened to and valued. The training is good”

“It is a nice home to work in. The staff team are good and support each other.”

This inspection was carried out on 29 October and 3 November 2015. Both visits to the service were unannounced. We brought our inspection of this service forward following concerns raised to our attention around care and safety of people who used the service.

Chester Lodge care home is a privately owned residential and nursing care service located close to Chester city centre. The service is based over three floors, which provide accommodation and personal care for up to 40 people. Access to the upper floor is via a passenger lift or stairs. Local shops and other amenities are a short distance away from the service. At the time of our inspection there were 35 people living at the service.

The service has 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. In addition there was a lead nurse at the service who had responsibility for overseeing clinical practise and care.

During our visit we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of the report.

People we spoke with said that they felt safe at the service and told us ‘I know someone will help me when I need them’. Relatives informed us that the staff do their best to look after people and keep them safe from harm.

Risks to people’s health and safety were not always identified or assessed. We identified the unsafe use of one person’s bedrails during the visit. The registered provider took immediate action to remove the risk. However we also found that robust risk assessments were not in place for the use of bedrails which meant people could be left at risk of harm or injury.

One of the concerns raised prior to the inspection was in relation to the management of pressure sores by staff. During this visit we found that sufficient checks were not always made on pressure relieving equipment. We found two mattresses that were on the wrong setting and identified faults with equipment. This meant that people using the service were at risk of harm.

People did not always receive their medication as prescribed. People’s medication administration records (MAR) had not been appropriately signed when medication was given. Care plan for PRN (as required) medication were not in place for staff guidance. Medication was not always stored in a safe and secure way.

Accident and incidents were not effectively monitored. Reviews did not identify risks or patterns to falls. There were no actions identified to ensure that people were kept safe.

The service was not clean. Several areas were dirty and in need of a deep clean. Unpleasant smells were detected in some parts of the building. The management of infection control was poor.

Fire safety management at the home required reviewing. We saw no evidence to support effective evacuation in the event of a fire. Flammable items were stored in rooms that had no fire detectors. We have requested the Fire authority to visit the service to complete an inspection.

Staff showed a limited understanding of their responsibilities in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The registered provider did not have policy and procedures in place with regards to the MCA. Staff practice showed that people’s consent was considered before any daily care or support was provided. We found that the registered manager had made some applications to the supervisory body under Deprivation of Liberty Safeguards, but this was only in relation to people choosing to live at the service. Supporting documentation did not reflect how complex specific decisions for people who may lack capacity had been made in their best interests.

Staff attended annual training sessions in areas such as moving and handling, first aid and safeguarding adults to update their knowledge and skills.

The mealtime experience was disorganised and did not promote a positive experience for people. Undignified practice such as putting plastic aprons on everyone was observed. Staff did not always respect people’s opinions and choices at mealtime. People were not always treated with dignity and respect. Some people told us that they felt staff spoke to them in a disrespectful manner at times. Others informed us that the staff were caring and did the best that they could to look after them.

Care plans did not always record people’s needs accurately. Records were not personalised to reflect people’s individual preferences about how they would like their care and support to be provided. Care plans did not always include accurate information for the management of wounds. Food and fluid charts were not always completed in detail to reflect what people had consumed on a daily basis. However, care plans identified what people’s end of life care wishes were. Staff were familiar with decisions that had been made with the GP and the people who were supported. Appropriate referrals to health professionals were made when any concerns regarding people’s health were identified.

The quality assurance system in place was not effective and did not monitor the quality of care and facilities provided to people who used the service. Issues we found as part of our inspection had not been identified or addressed through the provider quality assurance processes. The policy and procedures manual at the service required updating. Information contained within the documents was out of date and did not reflect changes to current practice, law and legislation.

The registered manager had a limited knowledge and understanding of the Health and Social care Act 2014 regulations and fundamental standards.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.