The inspection was unannounced and took place on 15 and 16 October 2018.

Clumber House Nursing 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. Clumber House is registered to provide accommodation with personal care for up to 36 people. The accommodation is located over two floors and there is currently a large lounge and dining room on the ground floor. The provider had built an extension which includes additional lounges and bedrooms, however this is not currently in operation. On the day of our inspection there were 29 people living in the home.

At our last inspection in September 2017 we found the provider was in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as the provider’s quality assurance systems were not effective and had not picked up the issues we identified as part of the inspection. We also made a few recommendations about a generic risk assessment for the property, updating medication policies and recording spot checks as part of the quality assurance systems.

At this inspection we found that there was a continued breach of Regulation 17 in relation to documentation and quality assurance systems and there was also a breach of Regulation 12 in relation to safe care and treatment. The service was rated requires improvement overall and this is the fourth time that the service has received this rating. You can see what action we have taken at the back of this report.

Clumber House has 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.

Risks to people were not always clearly considered or documented in care plans with appropriate risk assessments in place.

The registered provider did not have effective systems in place to assess and monitor the quality and safety of the service. Some of the issues which were identified as part of this inspection, had not been picked up by provider’s audits.

Staff had completed safeguarding training and safeguarding incidents were appropriately raised by staff. However, we found two instances where incidents had not been referred to the local safeguarding team.

Medication was being stored and administered safely. Regular medication audits were being conducted and any issues identified were addressed. There was scope for improvement in documentation around covert medication.

Registered providers are required to send notifications in relation to events or changes which occur in the home. We found that the provider had not sent all the necessary notifications as required by the regulations.

Staff recruitment was safe and appropriate checks were completed to ensure that staff were safe to work with vulnerable people. There were sufficient staff to meet the needs of the people living in the home and they were recruited safely.

Most of the care plans reflected people’s life history and their needs and were person centred. People and their relatives told us that the care they received was responsive to their needs. However, we found where there were changes or incidents that care plan evaluations had not been updated to reflect these issues.

People and their relatives felt confident that issues raised would be addressed. Complaints were recorded and dealt with in accordance with the provider’s complaints policy.

People and their relatives were positive about the staff working in the home, as well as the care they received whilst living there.

People’s privacy and dignity were respected by all staff membe

The inspection was unannounced and took place on 11 and 14 September 2017.

The last inspection took place on 7 April 2016. At that inspection we identified one breach of the relevant regulations in respect of fit and proper persons employed. At this inspection, we found that improvements had been made in this area, however we found the provider was in breach of a different regulation.

Clumber House is registered to provide accommodation with nursing and personal care for up to 36 people. It is located in a residential area of Poynton in Cheshire East. There are currently 32 single bedrooms at the location. There are two floors connected via passenger lift and two lounges on the ground floor. On the day of our inspection there were 30 people living in the home.

The home has a registered manager who had been registered since November 2012. 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 that the arrangements for the administration, storage and disposal of medication were not always safe. Topical creams were not dated when opened and there were no clear guidelines and policies in place in relation to PRN (medication given as required) medication. Medicine competencies were checked periodically but there was no system in place to ensure that this was done on a regular basis.

We asked staff members about training and supervision. They all confirmed that they received regular training and supervision throughout the year, however when we checked the records, we found that there was no process for checking when training needed updating and no clear plan in place as to when this would be carried out.

The home was staffed by a consistent team of suitably qualified and experienced staff who met the needs of the people living there.

We saw that the service had a safeguarding policy in place. This was designed to ensure that any safeguarding concerns that arose were dealt with openly and people were protected from possible harm. All the staff we spoke with confirmed that they were aware of the need to report any safeguarding concerns. However we did note that training in this area had not been updated.

We looked at recruitment files for the most recently appointed staff members to check that effective recruitment procedures had been completed. We found that appropriate checks had been made to ensure that they were suitable to work with vulnerable adults.

There was a flexible menu in place which provided a good variety of food to the people using the service. People were positive about the food that was provided.

We observed caring, positive relationships between staff members and the people living in the home.

We found that that care plans provided clear guidance to staff on how to support the people living at Clumber House. The plans were updated regularly and were clear. Where additional monitoring of people’s needs was required, records were consistently kept.

The provider had a quality assurance system in place and regular audits were being completed, however we found that some processes were not in place in relation to training to ensure that people remained up to date. We saw that many of the policies held by the home did not include up to date guidance and legislation or were missing information to guide staff on the correct procedures. The registered manager continually sought feedback from people living in the service, relatives and staff in order to improve the service. Staff members and relatives we spoke with were positive about how the home was being managed.

This inspection took place on 7 April 2016 and was unannounced. Clumber House Nursing Home is owned and managed by United Care (North) Limited. Clumber House Nursing Home is registered to provide accommodation for 36 people who require nursing or personal care and who are living with dementia. The registered provider has changed the layout of some of the bedrooms, as some were once used as double rooms and now only used for single occupancy. After the inspection it was confirmed by the registered manager that there are 32 single bedrooms at Clumber House Nursing Home. The home is located in a residential area of Poynton in East Cheshire. On the day of our inspection 30 people were using the service.

The service was previously inspected on the 18 June and 16 July 2015. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to the following: we found people who lived in the home were not treated with dignity and respect; people's records of care and treatment were not maintained securely; the registered person did not notify the Commission without delay of incidents specified in the relevant regulation; people were given care and treatment without their consent and the registered provider had not established and operated effective systems to investigate, immediately upon becoming aware of, any allegation or evidence of abuse. We issued a warning notice in relation to two of these breaches.

We found that the provider had taken appropriate action to address the areas of concern. The registered provider had established a safeguarding incident recording file that captured any safeguarding incidents involving people who live at the home. We viewed three Deprivation of Liberty Safeguards (DoLS) applications the registered provider had submitted, which had been subsequently granted by the local authority.

The service had a registered manager in place; however on the day of our inspection the manager was unavailable due to taking annual leave. 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.

During this inspection we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

We found that registered provider had failed to ensure that the people using the service were protected against the risks of unsafe or inappropriate recruitment practice, as some key records did not contain satisfactory information about any physical or mental health conditions relevant to the person’s capability to perform tasks.

The deputy manager was present during our inspection and engaged positively in the inspection process. The deputy manager was observed to be friendly and approachable and operated an open door policy to people using the service, staff and visitors. During the inspection we found Clumber House Nursing Home to have a warm and relaxed atmosphere and overall people living in the home appeared happy and content.

Feedback received from people using the service we spoke to was generally complimentary about the standard of care provided.

Staff were supported through regular on-going training, supervision and appraisal. A training plan was in place to support staff learning. There were however, gaps in the Mental Capacity Act 2005 (MCA) and Safeguards (DoLS) training. After the inspection, the registered manager confirmed in an e-mail that all staff will complete this mandatory training by the end of April 2016.

A process was in place for managing complaints and the home's complaints procedure was

We undertook an inspection of Clumber House on the 5th August 2014. During our visit we spoke with eight people who used the service, three visitors and six staff members including the home manager. We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

Below is a summary of what we found. The summary is based on our observations, including a SOFI during the inspection, speaking with people using the service, their relatives; the staff supporting them and from looking at records.

Is the service safe?

We undertook a tour of the building and looked at communal areas, bathing areas and after gaining permission some of the resident's bedrooms. The home and its facilities were very well maintained and clean. The bedrooms viewed looked comfortable and had been personalised by the person living in the home or their families. Bedroom doors had key locks should people choose to use them and the main doors were alarmed and secure. The building presented as being clean and comfortable and people told us they were able to personalise their rooms and they felt happy and safe and secure within the home. This meant that the premises protected people's rights to privacy, dignity, choice, autonomy and safety.

We saw that risks to people's health and wellbeing had been identified for areas such as falls and nutrition and risk assessments were in place to manage these so the people who lived at the home were safeguarded from unnecessary hazards.

There were appropriate procedures in place should anyone need to be subject to a Deprivation of Liberty Safeguard (DoLS) application or plan. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Is the service effective?

The care plans had been written to ensure that they focused on the person's individual assessed needs and on how they could be met. The care plans focused on providing support to an individual in different aspects of their daily life, for example how the person was to be supported with promoting their independence and any issues regarding their health so that they were kept as healthy as possible.

Visits from other health care professionals, such as doctors and district nurses were recorded so staff members would know when these visits had taken place and why and if any immediate changes needed to be made to the daily care plan.

Is the service caring?

We received positive comments about the home and staff members from the people living in the home and the three visitors we spoke with. Comments included; "It is super, X is very happy here and she has been made to feel at home. We have noted such a great improvement in her in the short time she has lived here" and "this is a fine place to live in, wonderful staff and services".

We observed that staff interacted well with the people they were caring for. They took time to ensure that they were fully engaged with the individual and checked that they had understood all communications. Before carrying out interventions with the people using the service staff explained what they needed or intended to do and asked if that was alright rather than assume consent. They also spoke to people informally and acknowledged them with a smile as they passed through the home and went about their daily tasks

The relationships we saw were warm, respectful, dignified and with plenty of smiles and laughter. The staff members we spoke with could show that they had a good understanding of the people they were supporting and they were able to meet their various needs.

Is the service responsive?

People told us that they had residents meetings and were able to discuss the running of the home. Comments included; "the home is good and we are told about everything that is going on", "staff make sure we are provided with all the information about the home. For instance they told us that one lounge would not be in use for some of the time today as they are cleaning the carpet".

The staff members we spoke to could show that they had a good understanding of the people they were supporting and they were able to meet their various needs. We also observed that they were interacting well with people and were responsive to their individual needs.

People told us that the activities co-ordinator discussed peoples wishes and arranged activities and interests accordingly.

Is the service well-led?

Information about the safety and quality of service provided was gathered on a continuous and on-going basis via audits and feedback from the people who used the service and their representatives, including their relatives and friends, where appropriate. The home manager 'walked the floor' regularly in order to check that the home was running smoothly and that people were being cared for properly.

The staff members we spoke with made very positive comments about the way the home was run. Comments included; "We are very happy that the manager is here, she supports us well and now we know the home is very well run. I am so glad she is here".

We carried out a responsive inspection on 19th December 2013 because we had received some information of concern about the service.

In this report the name of a registered manager appears who was not in post and not managing the home at the time of our visit. Their name appears because they were still a registered manager on our register at the time of our inspection. An interim manager was in post during our inspection.

We spoke with six people who used the service and they told us that they were involved in the care they received. However six people who used the service told us collectively, “We feel invisible, we have no staff leadership; we don’t know what’s going on”.

People told us they were satisfied with the care and support they received at the home. One person said, “I am satisfied with my care”. We noted that not all of the care plans were up to date and they required more detail about people’s needs.

We saw staff treating people in a kind and respectful manner but were hurried whilst carrying out their duties. People told us that the staff were mostly good and friendly to them. Two people commented, “They’re so busy” and “The poor girls are short staffed”.

We found that records required to be shared with other organisations and to protect the safety and wellbeing of people who used the service had not been completed.

We found that records to protect people against the risk of unsafe or inappropriate care had not been completed.

During our inspection we spoke to five people who lived in the home. They were all very happy with the care that they were receiving and were complimentary about the manager and the staff team. One person told us; "They respect my choices - I don't like my bedroom door shut at night so they arranged for me to keep it open." Another person said; "It's really nice here - The food is very good and there is lots of it."

We spoke to three relatives who were all very pleased with the care that their family members were receiving. One told us; "They get looked after well here. We don't have to worry anymore."

We spoke to five members of staff including the manager and the deputy manager. They all said that they enjoyed working at the home and had lots of support and training to do their jobs. We looked at the training records and saw that that all the staff had yearly mandatory training and additional training according to their job roles.

We looked at the safeguarding policies and procedures and found that adequate arrangements were in place to protect people from the risk of harm or abuse.

We looked at the quality assurance processes in place and saw that the home regularly carried out audits to check systems such as medication administration and infection control to maintain the health and safety of the people who live in the home.

This inspection took place on 18 June and 16 July 2015 and was unannounced. The home was last inspected in August 2014 when it was found to be complying with the regulations which applied to that type of service at that time.

Clumber House Nursing Home is registered to provide accommodation for 36 people who require nursing or personal care and who are living with dementia. It is located in a residential area of Poynton in East Cheshire. There were 32 people living in the home at the time of our inspection.

There was a registered manager at the home. 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 that most people felt safe at Clumber House Nursing Home and thought that the staff were caring. Medicines were administered safely in the home and the people who lived there benefitted from good support from local health and social services. Opinions varied about the food. The home was trying to develop more activities for the people who lived there.

We found a number of breaches of Regulations relating to dignity and respect, need for consent, safeguarding people who used the service from abuse and improper treatment, and good governance. We also found that the registered provider had failed to notify the Care Quality Commission of significant events as it is required to do by law. You can see what action we told the provider to take at the back of the full version of the report.