The inspection of Crimson Manor took place on 28 September and 3 October 2016 and was unannounced. The location had been most recently inspected during July 2015 and was judged as requiring improvement at that time.

Crimson Manor is a residential home, registered to provide care for up to a maximum of 20 people. Accommodation is provided in single en-suite rooms, over three floors, accessible by a passenger lift. There were 15 people living at the home at the time of this inspection.

The service had 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.

People told us they felt safe living at Crimson Manor. The registered manager and staff were aware of relevant procedures to help keep people safe and staff were aware of signs that may indicate someone was at risk of abuse or harm. Staff had received safeguarding training.

Staff were recruited safely and there were sufficient numbers of staff deployed to meet people’s needs.

Risks to people had been assessed, however, some of these were generic in nature and some did not detail risk reduction measures which were in place for individuals.

Staff had received training in order to administer medicines safely. However, although staff had been trained, they did not always follow correct procedures when administering medicines.

Staff told us they felt supported and we saw staff received regular training and supervision.

Where people lacked capacity and were being deprived of their liberty, the registered manager had made appropriate applications to the supervisory body in order for this to be authorised. The registered manager acted in accordance with the Mental Capacity Act 2005.

People were given choices throughout the day and we saw staff sought consent from people prior to providing care and support.

People received appropriate support in order to have their nutritional and hydration needs met. A variety of healthy snacks and drinks were offered throughout the day.

People’s rooms were clean and personalised. Pictorial signage was used throughout the home, to assist people to navigate around the home.

People told us, and we observed, staff were caring. People’s privacy and dignity were respected.

Care plans were person centred and contained information to enable staff to provide care and support to people. Appropriate information was shared between staff to enable continuity of care.

Complaints were well managed and people we spoke with told us they would feel able to make a complaint if the need arose.

The registered manager was visible throughout the home and knew people’s needs. We were told by staff, family members and a visiting professional that the home was well led.

The registered manager undertook regular audits in order to improve provision of service, although action resulting from these was not always recorded.

We carried out this inspection on 17 July 2015. The inspection was unannounced.

The service provides accommodation for up to 20 older people, some of whom may be living with dementia. On the day of our visit there were 10 people living at the home. Accommodation at the home was provided in single ensuite bedrooms set over three floors.

The registered provider is also registered with the Care Quality Commission as the registered manager of the service. 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 there had been a number of improvements at the home since our last inspection and did not identify any breaches in regulation.

People told us that they felt safe and well cared for; they told us they enjoyed the food and were enjoying the new activities programme.

There were some issues in relation to cleanliness and infection control.

Systems for managing medicines were safe.

Staff training was up to date. Systems for supporting staff were in place.

Staff were not always working in line with the requirements of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards.

Staff treated people with kindness and demonstrated a good understanding of the need to treat people with respect and dignity.

None of the people we spoke with raised any issues in relation to staffing, however we noted there were not always staff visible.

Some good care plans were in place but one of the ones we saw lacked the required detail.

People had access to meaningful activities.

People felt able to tell staff if there was something they were not happy with and we saw that concerns and complaints were managed well.

A programme of refurbishment was in place but we found that staff did not have a good understanding of how the environment could be adapted to support the orientation of people living with dementia.

Processes were in place for auditing the quality of service provision but these were not always robust. New systems were under development.

We carried out an unannounced comprehensive inspection of this service on 29 October and 8 November 2014. We identified a number of breaches of regulation and, in line with our enforcement process issued the provider with a notice of proposal to cancel their registration. The provider has made representations against this proposal which, at the time of this report, are being considered by the Care Quality Commission.

We undertook a focused inspection on the 24 March 2015 because we had received information of concern. This related to people who lived at the home being put at risk because there were not enough staff available to meet their support needs safely and that accidents had occurred as a result of this. We had also received concerns about the presence of the provider’s dog in the home and the conduct of the registered provider/manager.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Colne Valley Residential Home’ on our website at www.cqc.org.uk’

This inspection did not change any of the ratings made as a result of our comprehensive inspection in October/November 2014.

Colne Valley Residential Home provides accommodation for up to 20 people who require support with their personal care. The home mainly provides support for older people and people living with dementia.

The registered provider of Colne Valley is also registered with the Care Quality Commission as the registered manager of the service. 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.

When we arrived, we were met by a member of staff who introduced themselves as the manager. They told us they had previously worked at the home as a senior care assistant but had been asked by the provider to take on the role of manager. This person said they would be making application to the Care Quality Commission for registered manager and if successful, the provider would de-register as the manager.

When we conduct comprehensive inspections, we report our findings under the five domains: Safe, Effective, Caring, Responsive and Well Led. All our findings from this inspection come within the ‘Safe’ domain.

None of the people we spoke with raised concerns about staffing levels, however we were concerned that they were not always appropriate to the needs of the people living at the home. We saw that one accident had occurred because a staff member worked alone to support a person to use moving and handling equipment and this had resulted in the person falling. We also saw that a person had been taken to hospital following a fall in the lounge when no staff were present. Neither person sustained injury.

Most of the people we spoke with about the presence of the dog in the home were positive about it. However two people declined to comment. Some staff told us that the dog is locked out of the rooms when food is being served but two staff told us that the dog had pinched biscuits from people who live at the home.

Two members of staff told us they had been shouted at by the registered provider/manager in a communal area of the home; however there was no evidence that people who lived at the home had been affected by this.

We carried out this inspection on 29 October and 8 November 2014. The inspection was unannounced and was the first inspection of this service since the provider registered with the Care Quality Commission in August 2013.

This means that this was the first inspection of the service under the new provider.

The service provides accommodation for up to 20 older people, some of whom may be living with dementia. On the day of our visit there were 14 people living at the home. Accommodation at the home was provided in single ensuite bedrooms set over three floors.

The registered provider is also registered with the Care Quality Commission as the registered manager of the service. 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 people were being put at risk because robust procedures and arrangements were not in place to keep people safe. There were issues with the safety of the premises including very hot water, blocked fire exit, lack of security, unsafe furniture and poor standards of cleanliness and infection control.

Medicines were not stored securely and were not always administered as prescribed.

Accidents and incidents within the home were not audited and notifications had not been submitted as required to Local Authority Safeguarding, the Care Quality Commission or the Health and Safety Executive.

People’s needs had not been assessed and effective up to date care plans were not in place. People who lived at the home had not been involved in their care planning and there was no evidence of review of care.

These are breaches of regulations 9, 11, 12, 13, and 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

We observed that the majority of staff’s approaches to people who lived at the home were kind and respectful and people told us that staff were good. However, staff had not received appropriate training or support from the provider. Staff were unaware of the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. None of the staff had received training in caring for people living with dementia and some staff had not received appropriate moving and handling training.

There were not enough staff available to meet people’s care needs as staff were assigned to domestic duties within their care shifts.

Staff had not been recruited safely and some staff had not had any induction training.

These are breaches of regulations 21, 22 and 23 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Complaints had not been managed or responded to appropriately.

There were no systems in place for assessing and monitoring the quality of service provision, the safety of the service or for gathering people’s views.

There was a lack of leadership and the Care Quality Commission had received concerns about the attitude and conduct of the registered provider/manager.

These are breaches of regulations 10 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

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