This inspection took place on 31 January and 1 February 2018 and was unannounced. College House is registered to provide accommodation for up to 20 people. At the time of our visit there were 16 people living at the service.

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 2008 and associated Regulations about how the service is run. There was also a home manager who was responsible for the daily running of the home.

At our last inspection in December 2016 we rated the service overall as Requires Improvement. At that inspection we found breaches of Regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Following that inspection we told the provider to send us an action plan detailing how they would ensure they met the requirements of those regulations. At this inspection we saw the provider had taken action as identified in their action plan and improvements had been made. As a result of this inspection the service has an overall rating of Good.

Why the service is rated Good

The registered manager and staff followed procedures which reduced the risk of people being harmed. Staff understood what constituted abuse and what action they should take if they suspected this had occurred. Staff had considered actual and potential risks to people, plans were in place about how to manage these, monitor and review them.

People were supported by the services recruitment policy and practices to help ensure that staff were suitable. The registered manager and staff were able to demonstrate there were sufficient numbers of staff with a combined skill mix on each shift.

Improvements had been made to ensure the safe management of medicines. People were protected from the risk of cross infection. This was because appropriate guidance had been followed. People were cared for in a clean, well maintained, homely environment.

Improvements in staff induction and consistency in training helped ensure staff had the knowledge and skills required to carry out their roles effectively. They were supported by the provider and the registered manager at all times. People received a varied nutritious diet and told us they enjoyed the meals they received.

People received a service that was based on their personal needs and wishes. Changes in people’s needs were quickly identified and their care amended to meet their changing needs. The service was flexible and responded very positively to people’s requests. People who used the service felt able to make requests and express their opinions and views.

People were helped to exercise choices and control over their lives wherever possible. Where people lacked capacity to make decisions Mental Capacity Act (MCA) 2005 best interest decisions had been made. The Deprivation of Liberty Safeguards (DoLS) were understood by staff and appropriately implemented to ensure that people who could not make decisions for themselves were protected.

People benefitted from a service that was well led. An increase in the provider’s oversight meant that a significant number of improvements had been made to help ensure that people were safe and received quality care. The registered manager demonstrated a good understanding of the importance of effective quality assurance systems. There were processes in place to monitor quality and understand the experiences of people who used the service.

We carried out a comprehensive inspection of College House on 6 December 2016. Following a previous inspection undertaken in April 2016, we served Warning Notices for breaches of two regulations of the Health and Social Care Act 2008. The breaches related to safe care and treatment and good governance. Medicines were not being safely managed. Systems were not in place to audit and monitor quality and safety. Systems were not in place to assess and mitigate the risks to the health, safety and welfare of people and accurate records were not being maintained.

During this inspection we followed up compliance with these Warning Notices. We found the provider had taken sufficient actions to address the breaches stated in the Warning Notices. However, we still found there were breaches of the regulations with regard to medicines management and good governance.

Following the inspection in April 2016 we also issued requirement actions for two other regulations. We found effective recruitment procedures were not in place and staff did not receive sufficient training to enable them to safely carry out their roles. The provider wrote to us following this inspection in April 2016 and told us how they would achieve compliance with the regulations. During this inspection in December 2016, we found that sufficient improvements had been made with regard to recruitment procedures. We continued to find shortfalls in the provision of staff training. We identified a further breach of the regulation. The provider had not submitted notifications about specific events they are legally required to tell us about.

Whilst we saw that significant improvements had been made in some areas, there continued to be shortfalls repeated from the previous inspection where sufficient actions had not been taken. We have written to the provider, and we have asked that they send us a written report each month, and provide specific evidence and details of the improvements they have made. We will monitor the progress they make and will take further action if the required improvements are not made in a timely manner.

College House provides accommodation and personal care for up to 20 older people. At the time of this inspection in December 2016, there were 18 people living in the home.

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 2008 and associated Regulations about how the service is run.

People told us they felt safe and we observed they were comfortable with the staff that supported them. There were sufficient staff on duty to support people and recruitment procedures had improved since our last inspection. People received their medicines when they needed them. However, we found shortfalls and that improvements were needed to make sure the management of medicines was safe. Staff understood their responsibilities in relation to safeguarding people from abuse.

Staff understood the Mental Capacity Act 2005 and that they needed to obtain consent form people before they provided care and support. The service had complied with the Deprivation of Liberty Safeguards (DoLS), however staff knowledge varied. People living in care homes can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). The application procedure for this is called the Deprivation of Liberty Safeguards (DoLS).

People received support from healthcare professionals when required. Staff told us they received supervision and training. However, this was not sufficient and not always recorded. The provider’s induction programme did not fully incorporate the Care Certificate.

People spoke positively about the sta

We carried out a comprehensive inspection of College House on 20 November 2014. Breaches of the legal requirements were found. The breaches related to medicine management, cleanliness, staff training, consent, record keeping and the running of the home.

We carried out another comprehensive inspection of College House on 28 April2016. This was the first inspection of the home since it was registered under a new provider in March 2016.

College House is a 20 bedded home that provides accommodation for persons who require personal care. At the time of our inspection there were 18 people living in the care home.

There was a registered manager in post at the time of our inspection. 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 had remained in post following the change of provider.

At our comprehensive inspection on 28 April 2016 we found breaches relating to the care and safety of people using the service, as well as matters relating to record keeping, staff training, medicine management and the running of the home.

Some risks to people were assessed, however other risks had not been identified. Where risks had been identified, insufficient actions were taken to keep people safe. Hazards and risks were identified in the management of the environment and these posed a significant risk of harm to people using the service.

There were shortcomings with the management and security of people’s medicines. Medicines were not stored, recorded or administered safely. Whilst the provider had a policy and procedure in place, this did not provide instruction and guidance in some of the areas where shortcomings were identified.

The service provided sufficient numbers of staff. However, the staff did not receive adequate and sufficient training to enable them to meet people’s needs effectively.

We found the service was caring. People spoke positively about the staff and how well they were supported in the home. Staff enjoyed their roles and spoke with kindness about the people they provided care and support to.

Whilst efforts were made to address people’s needs, people’s care records did not accurately reflect all their support needs. Records were not always up to date and complete. This placed people at risk of unsafe or inappropriate care.

People were not fully protected when they were unable to provide consent to care and treatment. The Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which apply to care homes. This is to make sure people are not deprived of their liberty unless authorisations are in place.

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are taking enforcement action against the provider. We will report further on this when it is completed.