We carried out an inspection of Curzon House on the 4 and 8 June 2018. The first visit was unannounced with the second day being announced.

Curzon House 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. Curzon House accommodates 35 people in one adapted building. At the time of our visit, 8 people were living at Curzon House either permanently or for respite care.

The service had a manager who was applying to become registered with us. 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 manager was present during the days of our visit.

We previously carried out an unannounced comprehensive inspection of this service on 12 and 13 February 2018. At that inspection we rated the service as ‘requires improvement’ as we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

On this visit we found that all breaches in regulations had been addressed.

Our last visit found that the service was not always safe and this had resulted in a breach of Regulation 12 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

This was because risk assessments relating to falls were not always in place, medication recording systems were not accurate and training in supporting those who used pressure mattresses was not provided.

This visit found that falls risk assessments were in place and were reviewed regularly. Falls that people had experienced had been kept at a minimum, were analysed to determine patterns or trends were unavoidable and did not adversely put people at risk of harm.

This visit found that medication recording had been improved. Where medication errors had occurred, these had been backed up by auditing systems which were effective and appropriate performance management for staff involved in place.

This visit also found that training in assisting people who required pressure mattresses had been provided with staff having the knowledge and skills to best support people in using this equipment.

Our last visit found that the registered provider had not always worked within the principles of the Mental Capacity Act 2005. This had resulted in a breach of Regulation 11 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We had found that restrictive practices were carried out by staff with no reference to people’s best interests or capacity being recorded. This visit found that a process for making best interests about aspects of people’s lives was in place and was working effectively.

On our last visit we found that governance of the service was inadequate. This had resulted in a breach of Regulation 17 the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because auditing of care plans and medication systems had not picked up the shortcoming in medication recording or the lack of a person-centred approach to care plans. We had also found that oversight from the registered provider had not been effective.

This visit found that audits were in place with an ongoing commentary on how any issues were to be addressed. We found that a representative of the registered provider had conducted a detailed visit covering all aspects of the support provided to people who used the service. In turn actions identified were addressed or ongoing.

The premises were clean, hygienic and well maintained. All equipment used had been serviced regularly to ensure that people could use it safely.

Staff were aware of the types of abuse that could occu

We carried out an inspection of Curzon House on the 12th and 13th February 2018. The first day was unannounced and on the second day, the registered provider was aware of our intention to visit.

We previously inspected Curzon House on the 21st and 24th August 2017. The service was rated Inadequate overall and placed into special measures. We found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in respect of Regulations 9, 11, 12, 17 and18. This meant the registered provider had failed to ensure people were fully protected from the risk of unsafe care, their capacity to consent was not assessed, care was not personalised and there was ineffective oversight of the service. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to breaches.

At this inspection we identified repeated breaches of the regulations in relation to assessing and mitigating risks to people’s health and wellbeing, the safe management of medicines, records and good governance.

We will update the section at the end of this report to reflect any enforcement action taken once it has concluded.

Curzon House 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. Curzon House accommodates 35 people in one adapted building. At the time of our visit, 11 people were living at Curzon House either permanently or for respite care.

There was no 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. The service had appointed a new manager and they took up this post in November 2017.

On our previous visit adequate risk assessments were not in place. This visit found that whilst some improvements had been made risk assessments required further developments to be made. They did not always clearly identify all risks to people supported and actions staff needed to take in order to minimise the risk of harm.

Our last visit we found that care and records were not person centred. Although improvements in day to day care and support were evidenced, records were still not personalised. Consideration was paid to the proposed introduction of an electronic care planning system that was to be introduced during the weeks following this visit. We were able to look at the new system and found how this potentially would make care plans more person specific. However, in the meantime and before this system was introduced, care plans remained vague and not person centred. Care plan audits had not been undertaken as it was stated that the present care plans were not appropriate.

While people received medical assistance from other agencies such as GPs and hospitals; the registered provider had not always taken after-care into account through care planning. This had been clear through the lack of care planning in health conditions following hospital stays.

Staff demonstrated some understanding of the principles of the Mental Capacity Act 2005 and had received re-training in this. We found that while this training had been provided; it had not been fully embedded into care practice. There was a lack of a best interest decision making into aspects of a person’s care such as covert medication or other restrictive practices to protect people from the risk of harm. This meant that people were not fully consented about the care and support they received.

People received regular opportunities to access food and drink during our visit. However, records reflecting people’s intake of food and flu

We carried out an unannounced inspection of Curzon House on the 14th and 21st of August 2017 with a further announced visit on the 24th August 2017.

This visit took place in response to concerns that we had received following a serious incident that had occurred in the service. These concerned had focussed on the safety of people who used the service and the management of falls.

Our last inspection took place in May 2017 and the service was rated as good.

Curzon House is a residential care home which can accommodate up to 35 older adults who need residential care and who may also be living with dementia. Curzon House is predominately a short stay service however some people live there permanently. The home is owned by VIVO Care Choices Limited. All bedrooms have en-suite facilities.

On the days of our inspection twenty people were using the service at Curzon House. This included seven people who received permanent care with others receiving respite care.

The service had a manager who was registered with us in August 2017. 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.

During this visit, we identified a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to person centred care, safe care and treatment, consent, and good governance.

The risks faced by people in respect of nutrition and susceptibility of developing pressure ulcers were not taken into account. No risk assessments had been devised by the registered provider in respect of these risks. This had subsequently been addressed by the registered provider.

Risk assessments in relation to falls were lacking in detail and did not contain the information needed by staff to manage falls and prevent future re-occurrence. The registered provider informed us subsequent to the inspection that a new admission protocol had been introduced making specific reference to the high risk of falls that people faced.

People who did not have the capacity to use call alarms to summon help were reliant on staff physically checking them at night. The capacity to use these alarms had not been determined by the registered provider. Records indicated that gaps had occurred in the frequency of these checks.

Assistive technology designed to assist staff to monitor people at night in order to ensure their safety had not been introduced at the time of our visit but we were informed subsequent to the inspection that this was now in place.

Changes to the body structure of people in respect of minor marks such as scratches had only been partially investigated which meant that people were at risk.

The consent of people who lacked capacity to make decisions was not gained.

The principles of the Mental Capacity Act 2005 had not been fully implemented by the registered provider. An overview of a person’s capacity to make decisions was included at the assessment stage prior to admission but this only translated into whether a deprivation of liberty order was needed. Care plans did not include any details on how the principles of the Act could be used to gain consent from people or to make decisions in their best interest.

The registered provider informed us that improvements in Mental Capacity Act training and the gaining of consent had been subsequently introduced.

People who used the service and their families told us that they considered the staff team and manager to be caring. Staff gave us practical examples of how they promoted the privacy and dignity of people. This was confirmed through our observations. The deficiencies identified in this report meant that the service was not consistently caring.

Care plans were not person centred. There was no evidence t

Curzon House is a residential care home which can accommodate up to 35 older adults who need residential care and who may also be living with dementia. Curzon House is predominately a short stay service however some people live there permanently. The home is owned by VIVO Care Choices Limited. All bedrooms have en-suite facilities.

On the day of this inspection there were 22 people staying at Curzon House.

Our last visit on 29 October and 3 November 2014 identified that improvement was needed in relation to staff training and awareness of the Mental Capacity Act 2005 and staff supervision. Because of this, we rated the effective domain as ‘requires improvement’. Despite this the rating for the service had been assessed as good overall. This inspection identified that the required improvements had been made. The service met all the relevant fundamental standards and the rating remains Good.

People and relatives told us that the staff were kind and showed compassion and caring in their approach. They said they were well supported by the staff team.

People and relatives told us that they had no concerns or complaints about the service. They were aware of and had access to the registered provider’s complaints policy and would speak to staff if they had any concerns.

Care plans were well documented and held good information about the individual person. Risk assessments were in place as needed and were individually tailored to each person’s needs. All documentation was up to date. Medication was administered safely.

The interim manager understood the requirements of the Mental Capacity Act 2005 (MCA 2005) and the Deprivation of Liberty Safeguards (DoLS). This meant that they were working within the law to support people who may lack capacity to make their own decisions.

The interim manager had systems in place to protect people from harm and to record safeguarding concerns, accidents and incidents and to take appropriate action when needed.

Recruitment of staff was robust. Appropriate checks had been undertaken and people could be confident that staff were suitable to be employed at the home. Our observations and discussions with people who lived and stayed at the home and the staff team confirmed sufficient staff were on duty.

Staff were supported in their roles. Supervision, training, daily handovers and staff meetings were held on a regular basis. This meant that staff had the knowledge and training to enable them to fulfil their roles.

The environment was well maintained with good décor and was clean.

The registered manager used a range of methods to assess, monitor and improve the service. These included regular audits of the service and staff and service user meetings to seek the views of people about the quality of care being provided. A wide range of compliments had been received regarding the service.

Further information is in the detailed findings below.

We visited this service on 29 October and 3 November 2014 and the inspection was unannounced on the first day. This was the first inspection of this service, which was registered with the Commission on 19 March 2014.

Curzon House is registered as a care home service without nursing. They provide a respite service for people in the local area, where people do not live permanently, but visit for a specified period of time. Curzon House provides personal care for up to 38 older people. The home is split into two areas, downstairs an 11 bedded unit called the Saltney wing where people living with dementia stay and in the rest of the building 27 beds for people who require residential care. At the time of our visit there were 31 people staying at the home.

The registered manager had been the registered manager for 18 months. 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.

Some areas required improvement. We saw that staff did not fully understand the MCA and associated process and some training was not up to date. Therefore staff may not have the up to date knowledge and training to support people who were staying at Curzon House.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The Deprivation of Liberty Safeguards provides a legal framework to protect people who need to be deprived of their liberty for their own safety. From discussions with staff we noted they were not aware of the correct processes to apply for a DoLS if this was found to be in a person’s best interests. Applications to deprive people of their liberty had been submitted to the local authority but best interest meetings had not been held and people who used the service and their relatives may not have been involved in the process.

People told us that they were happy staying at Curzon House and they felt that the staff understood their care needs. People commented “They’re very kind and caring”, “Very courteous always treat me respectfully” and “Very nice.”

We found that people, where possible were involved in decisions about their care and support. Staff made appropriate referrals to other professionals and community services, such as the GP, where it had been identified that there were changes in someone’s health needs. We saw that the staff team understood people’s care and support needs, and the staff we observed were kind and thoughtful towards them and treated them with respect.

We found the home was clean, hygienic and well maintained in all areas seen.

We looked at care records and found there was detailed information about the support people required and that it was written in a way that recognised people’s needs. This meant that the person was put at the centre of what was being described. We saw that all records were completed and up to date.

We found the provider had systems in place to ensure that people were protected from the risk of potential harm or abuse. We saw the provider had policies and procedures in place to guide staff in relation to safeguarding adults. Therefore staff had documents available to them to help them understand the risk of potential harm or abuse of people who were staying at Curzon House.

We found that good recruitment practices were in place and that pre-employment checks were completed prior to a new member of staff working at the service. Therefore people who were staying at Curzon House could be confident that they were protected from staff that were known to be unsuitable.