The inspection took place on 12 February 2018 and was unannounced.

The last inspection was on 20 June 2017 when we rated the service Requires Improvement overall and in the key questions of Safe and Responsive. We did not find any breaches of Regulation, but we found that the provider needed to make improvements in order to achieve a Good rating overall.

At this inspection we found the provider had made the necessary improvements and we have rated the service Good in all key questions and overall.

Cloisters 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.

Cloisters Care Home is registered to accommodate up to 58 people in one building. The building has two units. The ground floor is for people living with the experience of dementia who may also have physical healthcare needs. The first floor is for people whose primary needs are physical healthcare needs, including people who are being cared for at the end of their lives. At the time of our inspection 54 people were living at the service.

The provider, Advinia Health Care Limited, is part of the Advinia Healthcare Group, who manages 16 care homes in the United Kingdom.

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 and associated Regulations about how the service is run.

People were happy living at the service. They told us their needs were met and they were treated with kindness and respect. Visitors explained they thought the service was well run and met people's needs. People were involved in planning their own care and were able to make choices about this.

The staff were happy working at the service. They felt supported. They had the training and information they needed to carry out their roles and responsibilities.

People received their medicines in a safe way. The risks to their safety and wellbeing had been assessed and planned for. The provider learnt from incidents and accidents and had made improvements at the service following these.

The environment was safely maintained, suitable and comfortable. The staff carried out checks on safety and on equipment being used.

There were procedures designed to protect people from the risks of abuse. People knew how to make a complaint, they felt the registered manager and provider listened to their concerns and took action when needed.

People were cared for in a way which met their needs and reflected their preferences. The staff worked alongside other professionals to make sure healthcare needs were being met. People had enough to eat and drink. They were able to participate in a range of social activities. There was evidence that some people's health and wellbeing had improved since they had lived at the service. People receiving care at the end of their lives were treated with dignity and respect.

The registered manager and provider's representatives were visible and well known. They operated effective systems for monitoring the quality of the service and making improvements. These systems included asking people using the service and other stakeholders for their views and opinions.

The inspection took place on 20 June 2017 and was unannounced.

The last comprehensive inspection of the service took place on 17 May 2016 when we found breaches of Regulation in relation to person-centred care and privacy and dignity. At the inspection of 20 June 2017 we found the provider had taken action to meet these breaches. We carried out a focussed inspection on 28 February 2017 to look at the way in which medicines were managed. This was following an incident relating to medicines management which was also investigated under the local authority safeguarding procedures. At this inspection we found that the service was managing medicines safely. We found this was still the case during our inspection of 20 June 2017 but we found that medicines were not always being stored at safe temperatures.

Cloisters Care Home is a nursing home for up to 58 older people. The ground floor is for people who are living with the experience of dementia and also have nursing needs. The primary needs of people living on the first floor were nursing needs, although some people also lived with the experience of dementia. The majority of people living on the first floor had complex needs with a variety of different medical conditions. Some people were being cared for at the end of their lives. At the time of our inspection 53 people were living at the service. The home is managed by Advinia Healthcare Limited, a private company who are part of a group which manage 16 residential and nursing homes and home care services in England and Scotland.

The registered manager had been in post since February 2017. They had previously worked at and managed other residential and nursing homes. 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.

Some of the records at the service were not up to date and did not accurately reflect changes in people's needs. We discussed this with the registered manager who was aware of the situation and was in the process of addressing this issue. We found that despite some records not reflecting the most up to date needs of people, the staff were aware of their needs and met these.

We found some aspects of the service were not always safe. For example, we observed an incident where a member of staff almost gave someone a drink which was not safe for them. We also found concerns about medicines storage temperatures and the provider had not sought assurances from their pharmacy before we alerted them to do this. Some people felt that the service did not have enough staff. We found that there were enough staff to meet people's needs but at times the staff were under pressure to make sure people's needs were met when they needed. The environment was safely maintained but there was a malodour in some areas of the building.

People were mostly happy living at the home and felt their needs were being met. The staff were kind, caring and polite. They offered people choices and took account of their wishes and preferences. People's health was monitored and the staff worked closely with other healthcare professionals to meet these needs. People were able to make choices about a range of freshly prepared meals. People's capacity to consent had been assessed and the provider acted within the principles of the Mental Capacity Act 2005.

The staff were appropriately trained and supported. They worked well as a team and had the information they needed to carry out their roles.

The culture of the home was open and inclusive and people using the service, their visitors and staff were able to contribute their ideas and felt listened to. The provider had a number of audits which helped to monitor and improve the quality of the service. There had been impro

The inspection took place on 28 February 2017 and was unannounced. The inspection was carried out by a pharmacist inspector to look at the way in which medicines were being managed at the home. This was because we had received information from the provider and the local Clinical Commissioning Group (CCG) about an incident relating to medicines which took place at the service.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Cloisters Care Home' on our website at www.cqc.org.uk.

The last inspection of the service was 17 May 2016. At this inspection we rated the service Requires Improvement because we found that people did not always receive care which met their social and emotional needs. Some of the staff did not always care for people in a person centred way or take account of their needs associated with having dementia. The staff did not always treat people with respect. The provider sent us an action plan telling us how they would make the required improvements.

The inspection of 28 February 2017 did not include a review of these previous concerns because it was a focussed inspection carried out by a pharmacist inspector to look at the management of medicines only. We will review other areas of the service at our next comprehensive inspection. Therefore we have not reviewed or changed the rating of the service at this time.

Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.

At this inspection we found that the provider had made suitable arrangements to ensure people were protected against the risks associated with the inappropriate treatment of medicines. People received their medicines as prescribed. Medicines were stored, administered and recorded appropriately.

The inspection took place on 17 May 2016 and was unannounced.

The last inspection took place 13 and 19 October 2015, when we found breaches of three Regulations relating to person centred care, good governance and the deployment of staff. At the inspection of May 2016 we found improvements in some areas, however, there were still risks that people did not receive care which was appropriate, met their needs and reflected their preferences.

Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. At the time of our inspection 52 people were living at the home. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.

There was a manager in post. She was in the process of applying to be registered 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 and associated Regulations about how the service is run.

People did not always receive care which met their social and emotional needs. Some of the staff did not always care for people in a person centred way or take account of their needs associated with having dementia.

The staff did not always treat people with respect.

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

People told us the staff were kind and caring. Most people felt their needs were met and people had consented to their care. We saw that people had detailed care plans which reflected their needs and preferences. Some of the care people received was kind and respectful. People were given the support they needed to stay healthy and eat well.

There were enough staff to support people and meet their needs. However, some of the time the staff did not work in a coordinated way so people had to wait for care. The staff received the training and support they needed to care for people and to understand their needs.

The service was appropriately managed and there were systems to audit and monitor the care people received. The provider responded to concerns raised by people, including taking action where we found they were not meeting the Regulations.

At our inspection on 28 June 2013 we found that people were not always involved in planning their care and people told us they were not always treated respectfully by staff. In addition to this we found that staff had not received adequate training, supervision and appraisal and therefore were not fully supported in their roles.

Following our inspection the manager submitted an action plan telling us what action would be taken to ensure these issues were addressed. The manager told us that the home would be fully compliant by 2 September 2013.

During this inspection we spoke with the manager, two other members of staff and five people who use the service. We found that people were involved in their care planning and supported to make choices with regards to their daily routines. People told us that staff treated them well. One person we spoke with told us, "staff treat me respectfully and I respect them too." Another person said, "they're absolutely brilliant, they [staff] come and chat with me, I am happy here."

We looked at training records and saw that staff had attended training in a range of areas to support them in developing/refreshing their skills and knowledge so that they could meet people's needs effectively.

We found that systems had been implemented to ensure that staff received regular supervision and annual appraisals to monitor their performance and identify any areas for development to support them in their role.

We visited the service because we had received information that the service might not be complying with essential standards of quality and safety. In particular concerns were raised about staff practices in relation to getting people out of bed early in the morning against their will from 4:30am to ensure people were up and dressed before staff came on duty in the morning at 8am.

We carried out an early morning visit to the home. When we arrived at 5:30am we found that all of the people using the service were in their beds and most people were still sleeping. We spoke with one of the nurses on duty and two other members of staff. We also looked at three people's care records and viewed the daily progress notes for all of the people with dementia care needs accommodated on the ground floor.

The staff we spoke with told us that there were a few people who were early risers but that everybody was supported to get up in the morning when they chose to do so. Staff also told us that there had been previous discussions between the day and night staff about expectations in relation to how many people were supported to get up by the night staff to reduce the workload of day staff in the morning rather than basing these decisions on people’s individual needs. This meant that people's individual needs and preferences were not always considered in terms of staff practice discussions in the home.

We spoke with the deputy manager, four other members of staff, 11 people who were using the service and two relatives who were visiting the home at the time of our inspection. We found that some people were unable to express their views about the service as they had complex needs. However, we used different methods to help us understand their experiences such as observation, speaking to people's relatives and reviewing care records.

We found that people's responses were mixed in relation to the staff working at the home. For example, one person said, "the girls (staff) are good" but another told us, "there are a few staff who are rough when they are helping me and say things like 'get over' but sometimes I am well looked after". Other people we spoke with also said that they had mixed feelings about the staff or made comments like, "they're (staff) ok I suppose, I don't like to criticise". Therefore people were not always treated respectfully and in a dignified manner by staff.

People's needs were assessed and care plans developed that took account of their likes, dislikes and preferences. Any identified risks were assessed and action taken to minimise these risks and keep people safe. People's health needs were met.

The home was clean and warm at the time of our visit and appropriate maintenance and health and safety checks were taking place to ensure that people were kept safe.

At our previous inspection staff were not receiving formal supervision. We found that a plan had been put in place and this was being addressed, however staff had not received adequate training and no staff appraisals had taken place.

Quality assurance systems were in place to monitor areas such as medication, pressure area care, nutrition and the use of bedrails. However, the records viewed did not show what action was taken to address any identified issues.

During the inspection we talked with six people using the service, two visitors and eight members of staff to get their views about the service.

People told us they were pleased with the care they received at the home. They said staff were attentive to their needs and ensured these were met. Comments we received included, “everyone looks after me well” and “I can go home and have peace of mind that [my family member] is being well looked after”.

People’s care plans generally addressed their needs but information about their backgrounds was not always available to ensure staff understood them as a ‘person’. Some of the arrangements to ensure people received safe and appropriate care were not adequate to ensure their welfare and safety.

Staff were aware of the need to maintain people’s privacy and dignity and people who talked with us said these were respected. However, their care plans did not address how their privacy and dignity would be maintained, such as when they were in bed with their bedroom doors left open.

People received information about their care and were given opportunities to make choices. However, care records did not always make clear how people or their relatives were involved in the care people received.

Staff received appraisals but did not always receive training and supervision in a timely manner to ensure they were appropriately supported in their job. The manager said they had plans to address this.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience; people who have experience of using services and who can provide that perspective.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

People who use the service told us that staff were kind and respected their privacy. They confirmed that staff treated them with care, respect and dignity. One visitor told us “we are delighted with the care, they are very good”. Another visitor said “I’m happy with the care”. People’s comments about their experience of living at Cloisters Nursing Home included “they are very good to me” and “I’m very well looked after”. One person said "your're just told about treatment and not given any options".

We found during the inspection that, for people who remained in their bedrooms the doors were kept open and it was not clear that they had made this choice.

People confirmed they had a choice of menu and that their religious and cultural menu requirements were met. People's comments and description of the

meals included, "the food is nice", "you choose what you want." One person told us the food was "luke warm".

The majority of people indicated to us that they felt safe at the home. They told us if they had no concerns or complaints about their care but would speak with the deputy manager or the staff if they needed to. One person said “I have no worries about abuse and another said “If I don’t like anything I let them know”

The feedback we received from people who use the service was positive. They told us that staff were available when they needed them and supported them to take part in activities that they enjoyed. They said that staff treated them well and provided good care. One person told us, “I’ve got no complaints – they treat me very well. I’m quite happy here” and another said, “The staff are really good, they’re brilliant”. People also said that staff helped them get medical treatment if they needed it and helped them to stay healthy.

People told us they could choose how they spent their time and that they could have privacy when they wanted it. They said they felt safe living at the home and that they were asked for their opinions about the way the home is run and about the care they received. People said that staff were available when they needed them and responded to their needs promptly. One person told us, “When I call them, they’re with me straight away” and another said, “If I ask for something, they get it done”.

The inspection took place on 13 and 19 October 2015 and was unannounced.

The last inspection took place on 22 and 26 June 2015 when we found four breaches of the Health and Social Care Act 2008 and associated Regulations. We issued two warning notices telling the provider they needed to make the necessary improvements by 10 August 2015.

At this inspection we found that improvements had been made. The previous breaches and the warning notices had been met. However, we identified risks to people’s safety and wellbeing at this inspection.

Cloisters Care Home is a nursing home for up to 58 older people with nursing needs. The ground floor was also for people who were living with the experience of dementia. At the time of our inspection 48 people were living at the home. The home is managed by Advinia Healthcare Limited, a private company who manage 16 residential and nursing homes and home care services in England and Scotland.

There was a manager in post. She was in the process of applying to be registered 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 and associated Regulations about how the service is run.

There were not always enough staff deployed to keep people safe and to meet their needs.

People’s capacity to consent and make decisions had been assessed and recorded. However, in a small number of cases the records relating to specific decisions did not always indicate whether there were discussions with a person who had been assessed as having capacity.

Although there was a range of organised activities, people’s individual interests, social and emotional needs were not always met.

The provider had not always identified and mitigated risks to people’s safety and wellbeing.

The provider had taken action to meet the concerns identified at the inspection of 22 June 2015 and had put in place measures to help keep people safe from harm.

We found that some people were at risk of choking and this had not always been managed appropriately, however, during the inspection the provider took action to remedy this and produced clear information and guidance for staff to ensure that people always received the individual support they needed.

Improvements had been made to the way in which people’s medicines were managed so they received their medicines as prescribed.

Improvements had been made to risk assessments and the way in which staff supported people to stay safe.

Improvements had been made to the maintenance and cleanliness of the environment.

The provider had appropriate safeguarding procedures and the staff were aware of these.

There were checks on staff suitability before they started working at the home.

The staff were appropriately trained and supported to carry out their roles and responsibilities.

People’s healthcare needs were appropriately assessed, monitored and met.

People’s nutritional needs were met.

Most of the staff were kind, considerate and polite towards people. They had good relationships with the people who they supported and their visitors. The provider had introduced staff training which helped them to experience what it felt like to be cared for and the staff told us this had given them a different perspective on their work.

Some staff worked in a task centred way, and although they were not unkind, they tended to focus on the task they were doing rather than the person they were caring for. The manager was aware of this and was providing more training and support for the staff to help them improve the way in which they cared for people.

The staff had assessed and planned care to meet people’s needs. They regularly reviewed these plans.

People knew how to make a complaint and felt confident their complaints would be investigated and acted upon.

There had been improvements in the care and treatment people at the home received and the improvements were continuous and ongoing.

The manager and the provider regularly audited the service and had plans to make further changes to the service. People living at the home, their visitors and the staff reported the culture and the atmosphere at the home had improved and was open and inclusive.

Following our last inspection, we placed the service in special measures. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. As the provider has demonstrated improvements and the service is no longer rated as inadequate for any of the five questions, it is no longer in special measures.

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