This inspection was carried out over two days on 06 and 07 February 2018. Our visit on 06 February was unannounced.

At the last inspection carried out in November 2016, we rated the service as 'requires improvement'.

We identified five breaches in the regulations relating to the management of the home, recruitment procedures, staff training, deprivation of liberty safeguards and the premises. The provider had not carried out the required recruitment checks to ensure that staff were safe to work with vulnerable people; an authorisation was not in place in relation to deprivation of liberty safeguards for one person who lived at the home; staff had not received all the training the provider required to ensure that people were safely and effectively supported; the property was tired in parts and improvements were needed to help the overall appearance of the home and some of the furnishings; and action identified during audits was not always taken.

Following that 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, effective, responsive and well led to at least good. At this inspection we found improvements had been made and the service is no longer in breach of the regulations.

Cleggsworth Care Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

It is registered to provide personal care and accommodation for up to 38 people. It caters for both long term and respite stays. The home is located in Smithybridge village, and at the time of the inspection there were 33 people living at 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.'

People told us they felt safe at Cleggsworth Care Home. When we spoke with staff they were able explain how they ensured people were protected from abuse or harm. Risks to individuals were assessed monitored and reviewed in line with people’s preferences.

We saw that people were supported by a trained staff team who knew the needs of the people who used the service. Procedures for recruiting new staff were sufficiently robust to help ensure that people were protected from the risk of unsuitable staff being employed, and the level of staff was sufficient to meet the needs of the people who used the service. All staff received regular supervision, and had undertaken relevant training to carry out their tasks. Senior staff were trained to administer medicines and we saw procedures were in place to ensure the safe management of medicines.

People told us that they were consulted about how they wanted their care to be delivered. We saw that the service had good systems in place to assess people’s needs prior to their admission to Cleggsworth Care Home, and needs were reviewed on a regular basis. The care plans we looked at gave a good indication of people’s abilities and instructed staff how to deliver care in the way the person preferred.

People told us that they were unhappy with the food provided. When we informed the registered manager and area director about this they immediately put plans in place to improve the food quality, and consulted all the people who used the service to develop a menu more to their taste.

When people were being deprived of their liberty, the correct processes had been followed to ensure that this was done within the current legislation. Staff understood issues around capacity and consent, and offered people choices to support their independence.

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This was an unannounced comprehensive inspection, which took place on 29 and 30 November and 6 December 2016. We brought forward this inspection because we had received information of concern and we wanted to be sure that the service was meeting the regulations.

Cleggsworth Care Home is registered to provide personal care and accommodation for up to 38 people. It caters for both long term and respite stays. The home is located in Smithybridge village, which has a variety of shops and other amenities close by. It is near to public bus routes and the train station is in close proximity. At the time of the inspection there were 25 people living at the service.

The service had a registered manager in place. 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 2008 and associated Regulations about how the service is run. The registered manager of the service was available and participated in the first day of the inspection.

We found five breaches in the Regulations relating to the management of the home, recruitment procedures, staff training, deprivation of liberty safeguards and the premises.

The provider had not carried out the required recruitment checks to ensure that staff were safe to work with vulnerable people.

We found that an authorisation was not in place in relation to deprivation of liberty safeguards for one person who lived at the home.

Staff had not received all the training the provider required to help ensure that people were safely and effectively supported.

We found that the property was tired in parts and improvements were needed to help the overall appearance of the home and some of the furnishings.

There were numerous quality assurance systems in place, however although they gave evidence of shortfalls the identified action needed to make improvements was not always taken.

We recommended that a review of activities is undertaken. This needs to be done to ensure that opportunities are made available to people to participate in activities to help promote their emotional and social wellbeing.

You can see what action we told the provider to take at the back of the full version of the report.

People and the visitors we spoke with told us that they generally felt safe at the service. There were systems in place to help ensure staff were supported to report any abuse they witnessed or suspected.

There were sufficient staff on duty to meet people’s personal care needs.

There were procedures in place to ensure people received the appropriate support to manage their medicines. Systems were in place to help prevent and control the spread of infection.

The atmosphere at the service was relaxed and friendly. We saw many examples of good interaction between people and staff, however both people who use the service and some staff said there were a small number of staff who were unreliable and not using their initiative.

There was a system in place for handling and responding to complaints. People told us that they were confident that the registered manager would deal with any concerns that they raised.

People and staff spoke positively about the registered manager and thought that the service had improved whilst they had been in charge of the running of the home.

Cleggsworth Care Home is registered to provide personal care and accommodation for up to thirty eight people. It caters for both long term and respite stays. The home is located in Smithybridge village, which has a variety of shops and other amenities close by. It is near to public bus routes and the train station is in close proximity. At the time of the inspection there were twenty seven people living at the service which is divided between two floors.

We last carried out an unannounced comprehensive inspection on 9 June 2015. We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This resulted in us serving two warning notices and making one requirement action. The overall rating for this service was ‘Inadequate’ and the service was therefore placed in 'Special measures'. A service in “Special measures” is kept under review and inspected again within six months. The expectation is that a service found to have been providing inadequate care should have made significant improvements within this timeframe.

The warning notices stated that the service must be compliant with these regulations by 30 September 2015. The service sent us an action plan informing us what action they intended to take to ensure they met all the regulations. They informed us they would be compliant with these by November 2015 and requested an extension until that date, which we agreed.

This was an unannounced comprehensive inspection which took place on 12 November 2015 to check the required improvements had been made and to follow up on what action had been taken to address the warning notices and requirement actions. We found that they had met the warning notices, the requirement action had been complied with and significant improvements had been made. As a result the service has been removed from “special measures”

The home did not have a registered manager; however our records showed the current manager has made an application to register with the Care Quality Commission. 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.

Improvements had been made in staffing levels. We were shown a copy of the duty rota. We saw that four care workers were on duty between 8am and 8pm. Since our last inspection a senior care worker was now on duty during these times, providing cover between both floors. This is an increase in staffing levels. During our inspection we observed that call bells and requests for assistance were answered promptly and there were sufficient staff to meet peoples needs. Despite this increase in staffing provision some people we spoke with thought that at times there were not enough staff available to support people promptly.

The home was clean and equipment was serviced and well maintained. Areas of the home had been redecorated and new furnishings and fittings had been purchased. There was a planned programme of ongoing improvements.

People we spoke with felt safe at Cleggsworth Care Home. Policies and procedures were in place to safeguard people from abuse and staff had received training in safeguarding adults. They were able to tell us how to identify and respond to allegations of abuse. They were aware of the whistleblowing (reporting poor practice) policy.

Staff were safely recruited and received the training and support they needed to carry out their roles effectively. Staff told us they liked working in the home and were positive about the improvements the new manager had made.

People told us the staff were caring and that they were well cared for. During the inspection we found the manager and staff to be caring and responsive to people.

We found there were safe systems in place for managing medicines.

The manager and staff demonstrated a good understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA and DoLS provide legal safeguards for people who are unable to make their own decision.

People’s care records were detailed and person centred. They contained good information to guide staff on what was important to people and the care and support people required. Risks to people’s health and well-being were identified and plans were in place to reduce or eliminate the risk. We did note that for one resident this was not done in a timely manner.

People were supported to access health care services when necessary. Improvements had been made in the recording systems to help ensure health care professionals advice was acted upon.

A programme of activities within the home had recently been introduced.

Procedures were in place to prevent and control the spread of infection. Systems were in place to ensure all necessary health and safety checks were completed. There were procedures in place to guide staff in the event of an emergency that could affect the provision of care, such as loss of gas, electricity, heating or breakdown of essential equipment.

We found there was a robust system in place for quality assurance. Weekly and monthly checks had been introduced to assess, monitor and review the service. Records were kept of any issues or concerns and any actions taken to address them.

We saw there was a system for gathering people’s views about the service and acting upon suggestions and ideas.

There was a system in place for dealing with complaints about the service. People told us complaints were acted upon and they had confidence the manager would deal with any concerns.

People were complimentary about the new manager and the recent improvements that had been made and said the manager was approachable.

Cleggsworth Care Home is registered to provide personal care and accommodation for up to 38 people. The home is located in the village of Smithybridge and is close to local amenities, bus routes and the train station. This was an unannounced inspection which took place on 9 June 2015. There were 26 people living in the service at the time of our inspection.

We last inspected this service on 21 January 2014 and found the service to be compliant in the outcome we assessed.

The home had 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.

We found a number of breaches of the Health and Social care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of the full version of this report.

Safeguarding procedures were robust and members of staff understood their role in safeguarding vulnerable people from harm.

We found that recruitment procedures were thorough so that people were protected from the employment of unsuitable staff.

People who used the service and their relatives expressed concerns about staffing levels. We saw that people were kept waiting for some time when they required assistance from staff.

The standard of cleanliness throughout the home was below an acceptable standard. There were also unpleasant odours in some areas of the home.

A member of staff qualified to administer first aid was not on duty for all shifts. This put people at risk of inappropriate care in the event of an emergency.

People’s views about the meals varied. Some people told us the meals were good others said their personal preferences were ignored.

Only one of the showers in the home was fully operational. The other two showers and both baths were out of order.

People were registered with a GP and had access to a full range of other health and social care professionals.

Visitors were welcomed into the home at any time.

We saw that members of staff were respectful and spoke to people in a friendly manner. Although people said staff listened to them they did not always take any action.

Although a member of staff was designated to organise activities within the home people told us there were not enough and there was nothing suitable for people with a dementia.

A copy of the complaint’s procedure was displayed in the home. Although the registered manager had investigated seven complaints in the last year some people said the concerns they had raised had not been addressed.

Members of staff told us they liked working at the home and found the registered manager approachable and supportive.

People who used the service and their representatives had not been given the opportunity to express their views about the service by completing a survey or attending meetings.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service 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."

The purpose of this inspection was to follow up on what improvements had been made in relation to information held about the current and changing needs of people cared for at the home.

The provider had sent us an action plan prior to this inspection informing us of the action taken to make the necessary improvements needed.

Information looked at during the inspection was found to be well organised, kept under review and provided information about the current needs of people. Minor improvements were needed to some records to show the relevant and sufficient information was provided clearly showing the action taken by staff.

The purpose of this inspection was to look at what improvements had been made since our last inspection in April 2013.

There had been a further change in management at the home. However feedback from staff and people living at the home was positive about the new manager and her ability to manage the home. One person who lived at the home told us “She deserves it!”.

We found that improvements had been made to some of the records. These included people’s care files, staffing training and development information and systems to show that the service was being monitored. The manager acknowledged that further improvements were needed to the care plans so that they accurately reflected the current and changing needs of people.

We found that staffing levels had not been maintained due to changes in the staff team. The provider advised us that this was being addressed. Once new staff were in post staffing levels would be increased to sufficient levels.

Opportunities for staff training and development were being provided.

Systems had been developed to show that areas within the home, such as medication, care records and health and safety, were being monitored. Opportunities were also made available for people living at the home to comment about the quality of the service provided.

The provider had not kept CQC informed of events that had taken place with home to show that relevant action had been taken ensuring people were kept safe.

The purpose of our inspection visit was look at what action the provider had taken to address the Warning Notice served by the Care Quality Commission (CQC) in May 2013 in relation to staffing arrangements at the home.

Prior to our inspection visit the provider had sent us information telling us what action they had taken.

We found that suitable arrangements were in place. Staffing levels provided carers with sufficient time to support people in a more dignified and unhurried way ensuring their needs were met.

Arrangements for ‘out of hours’ support needed to be formalised so that staff knew who to contact if they needed additional advice and support.

We previously visited the home on the 14 March 2013 due to concerns that had been raised with us. At that time we found that improvements were needed with regards to the nutritional needs of people at staffing arrangements.

Prior to this inspection visit we had been aware that the registered manager of the home had tendered their resignation. A new manager had recently been appointed.

During this visit we found that suitable meal arrangements were now in place to meet the nutritional needs of people.

We found that staffing arrangements were still not sufficient to meet the individual needs of people at the home, providing people with regular supervision and interaction with staff.

We also looked at the individual care records for people. Whilst information had been regularly reviewed, some of the records did not clearly direct staff in the safe delivery of care.

Arrangements for staff training and development needed improving ensuring staff had the knowledge and skills needed to meet the varying needs of people living at the home.

Systems to monitor and review the quality of service provided were not up to date ensuring people benefited from safe and effective care.

We carried out this unannounced inspection because concerns had been raised with us about the home. We had been told that staffing levels were not high enough to provide activities for people and there was no on call system to call for extra staff in an emergency. We had also been told that the manager was off work and no-one knew when she would return. In addition we had been told that food often ran out and people were given very little choice.

We spoke with four care workers, the cook, and three people living at the home. We saw that there had been a food delivery the day prior to our inspection so there was enough food available. People told us “The food is rubbish, and it’s never very warm” and “It’s terrible. It’s never been as bad as this while I’ve been here”. We were told that no drinks were provided between approximately 6.30pm and breakfast the next morning.

We were told by a care worker “There’s time to do what we need to do at a fast pace, but we can’t spend time with [people]”. Staff also told us they had worked without pay to support their colleagues. We were told that a lot of people had high dependency needs that required the assistance of two care workers on duty. This meant there were no other staff available to help other people if they needed support.

During our visit we spent time chatting with several people who were able to tell us about what it is like to live at Cleggsworth House. This included a discussion about the activities and the meals provided at the home. People told us that the food had been poor. However this had been raised with the manager who had since spoken with kitchen staff. Following this, new menus had been developed and people said “things have improved”.

People also told us that they were not happy with the changes made to the communal areas. Previously the home had a large lounge and separate dining room on the ground floor. In addition there was a lounge/dining room on the first floor. Following a meeting with relatives to discuss the changes the upstairs room had been created into a dining room and the two rooms downstairs were now lounges.

People told us that whilst relatives had been consulted about the changes they had not. They told us that whilst “some residents were not able to ‘speak for themselves’ about events within the home, they were”. People had since raised this with the provider. They said that they had been advised that the changes were for a trial period and would be reviewed in a few weeks time. The people we spoke with were still unhappy about this.

People did however speak positively about the redecoration of the lounge and dining room. They felt this had “improved the environment, making it brighter and more welcoming”.

During our discussions we found that people had been worried about a further management change within the home.

People spoken with told us that they had been unsettled and had considered whether they should remain at Cleggsworth House. They told us “We were not kept informed about the changes that were taking place” and “It’s very unsettling”. However they were now happy with the current management arrangements and hoped that no further changes would be made.

During our visit on the 11 October 2011 we spoke with one relative and two people who used the service. The people who use the service told us that they understood about their care and treatment and knew what their medicines were for.

We were told that there was “Not a lot to do” and that people tended to “Sit around watching television”. One person told us that they had discussed with the manager about changing where they went for treatment. The manager had then arranged for this to be done. The people that we spoke to were complimentary about the care being given.

A visiting district nurse told us that they had no concerns about the care being provided and that since the appointment of the new manager “Things were ticking over nicely”. One person told us that their relative was “Very well looked after”.

We also spoke with staff, they told us that they felt the home “had made a lot of progress”, “the team was working well together” and “staff morale had improved”. They were also enjoying working with the new manager.

We spoke with the local authority quality monitoring team following our visit. They too had recently carried out a monitoring visit at the home. We were told that their assessment of the service was that improvements needed were being made and people were receiving a better service. We were also told that a panel meeting was to be convened to discuss the current placement suspension. Following our visit we were informed by the local authority that the placement suspension had been lifted with immediate effect.

Due to the nature of this review we did not seek the views of people living at the home at this time.

Information was received by CQC from the local authority Commissioning Team following one of their quality monitoring visits. Concerns were raised with regard to the number of accidents that had occurred and the standard of care provided for people. Because of this the Commissioning Team had made regular visits to the home to review the standard of care provided.

During our visit we spoke with family members for one person living at the home. They were happy with the care provided for their relative and felt they had been settled since moving into the home some years earlier. They were concerned that their relative may need to move due to changing health needs and the negative impact this may have.

They also acknowledged that there had been some changes at the home, however appeared to have some confidence in the new manager.

We also spoke with the relatives of one person prior to our visit. They were very concerned about the poor standard of care received by their relative. A formal complaint had been made to the local authority, which had been referred to the safeguarding team for the matter to be investigated.