We carried out this inspection on 16 August 2018. The inspection was unannounced. This meant no-one at the service knew we would be visiting.

Dearne Hall is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Dearne Hall is registered to accommodate 48 older people. At the time of the inspection 44 people were living at the home. The home has three floors. The middle floor is for people living with dementia, the ground and top floor is for people who require personal care, some of whom are living with dementia.

Our last inspection at Dearne Hall took place on 5 and 15 June 2017. The service was rated Requires Improvement overall. We found the service was in breach of three of the regulations of the Health and Social Care Act 2008 (Regulated Activities) 2014. Regulation 12, Safe care and treatment, Regulation 19, Fit and proper persons employed and Regulation 17, Good governance.

Following the last inspection, we asked the provider to complete an action plan to show what they would do, and by when, to improve the key questions asking if the service was safe, effective, responsive and well led, to at least good. The registered provider sent us an action plan detailing how they were going to make improvements. At this inspection we checked the improvements the registered provider had made. We found sufficient improvements had been made to meet the requirements of the Regulations.

There was a manager at the service who was registered with the CQC. 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 living at Dearne Hall told us they felt safe and they liked the staff. Relatives we spoke with felt their family member was in a safe place and did not have any concerns about their family member’s safety.

Regular checks of the building were carried out to keep people safe and the service well maintained.

Staff confirmed they had been provided with safeguarding vulnerable adults training, so they understood their responsibilities to protect people from harm.

There were sufficient staff to meet people’s needs safely and effectively.

The service used effective recruitment procedures which helped to keep people safe.

We found systems were in place to make sure people received their medicines safely.

Staff were provided with relevant training and supervision to make sure they had the right skills and knowledge to support people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People enjoyed the food provided and were supported to receive adequate food and drink to remain healthy.

We found the home was clean, bright and well maintained.

People had access to a range of health care professionals to help maintain their health.

People were treated with dignity and respect and their privacy was protected. People, their relatives and health professionals we spoke with made positive comments about the care provided by staff.

A range of activities were available both inside and outside the home to provide people with leisure opportunities.

People living at the home and their relatives said they could speak with the registered manager or staff if they had any worries or concerns and they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. Regular checks and audits were undertaken to make sure full and safe proce

This inspection took place on 5 and 15 June 2017. The inspection was unannounced. An unannounced inspection is where we visit the service without telling anyone we are visiting. The service were aware we would be attending for a second day, they did not know when.

Dearne Hall is a residential care home registered to accommodate 48 older people. At the time of the inspection 45 people were living at the home. The home has three floors. The middle floor is for people living with dementia, the ground and top floor is for people who require personal care, some of whom are living with dementia.

The service had a 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 and associated Regulations about how the service is run.

On 5 July 2016 the Care Quality Commission carried out an inspection and found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we checked and found that whilst some improvements had been made, further work was required to fully comply with the regulations.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Systems were in place to manage risks to people and the service to ensure people, others and the environment were safe. The registered provider had not always been effective in managing risks to people, such as people’s nutrition, moving and handling and pressure area care.

Health professionals were contacted in relation to people’s health care needs such as doctors and community health teams. However, improvement was required to ensure staff carried out any changes that were made and that this was recorded accurately in people’s care files.

Improvement was required so that medicines were stored safely and that better systems and processes were in place to monitor the recording and administration of topical medicines.

Information and documents in the recruitment of staff did not include all the required information to support a robust recruitment process.

There were systems in place to assess and monitor the quality of service provided, but these had not always been effective in ensuring compliance with regulations and keeping people safe.

Staffing levels were sufficient to meet people’s needs, although some people felt more staff were required as staff were always busy and did not always respond to their needs in the time they felt appropriate.

There was a system in place for staff to receive training and supervision so they had appropriate skills to carry out their roles, but the implementation of the registered provider’s annual appraisal procedures required embedding.

There were systems in place to make sure people were protected from abuse and avoidable harm.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. However, we found policies and systems in the service did not always ensure the service complied with the Mental Capacity Act.

Meal times were a positive experience for people, with choices available.

Staff had developed positive relationships with people. They provided not only the physical care people needed, but also considered the quality of life of each individual.

Some people and their families felt there could be more and a better variety of activities.

People and relatives told us staff were caring and treated them or their family member with respect.

People were confident in reporting concerns to the manager and registered provider and felt they would be listened to.

This inspection took place on 5 July 2016. The inspection was unannounced. An unannounced inspection is where we visit the service without telling the registered persons we are visiting.

Dearne Hall is a residential care home registered to accommodate 48 older people. At the time of the inspection 48 people were living at the home. The home has three floors. The middle floor is for people living with dementia, the ground and top floor is for people who require personal care, some of whom are living with dementia.

The service did not have a 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 and associated Regulations about how the service is run. The person managing the home was not present during the inspection, but the area manager was able to confirm an application to register had been submitted.

Feedback from people, relatives, staff and other stakeholders was that the manager provided effective leadership to the service and provided opportunities for people and staff to express their opinions on the quality of the service provided and the running of the home.

On 24 February 2015 the Care Quality Commission carried out an inspection and found a breach with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At this inspection we checked and found that improvements had been made to meet that breach of regulation, but found a further breach of four regulations. You can see what action we told the provider to take at the back of the full version of the report.

When we spoke with people who used the service they all told us they felt safe. Relatives spoken with did not raise any concerns about mistreatment or inappropriate care provision of their family member. Staff had received safeguarding training and were confident the manager would act on any concerns.

We found staffing levels were sufficient to meet people’s needs, but that recruitment of staff did not include all the relevant information and documents required to ensure staff were suitable to work with vulnerable people.

Systems and processes were in place for the safe administration of medicines.

Systems were in place to manage risks to people and the service to ensure people, others and the environment were safe. The registered provider had not always been effective in managing those risks, such as people losing weight and fire safety.

Staff received induction, training, supervision and appraisal relevant to their role and responsibilities.

The service followed the requirements of the Mental Capacity Act 2005 (MCA) Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who lacked capacity to make important decisions themselves.

Meal times were a positive experience for people, with choices available.

Staff had developed positive relationships with people, providing not only the physical care people needed, but also considering the quality of life of each individual person.

People and relatives told us staff were caring and treated them or their family member with respect.

Health professionals were contacted in relation to people’s health care needs such as doctors and community health teams.

People were confident in reporting concerns to the manager and registered provider and felt they would be listened to.

There were systems in place to assess and monitor the quality of service provided, but these had not always been effective in identifying improvements needed and to ensure improvement to achieve compliance with regulations.

We carried out this inspection on 24 February 2015 and it was unannounced.

Our last inspection of the service took place on 22 January 2014 and we found the service was meeting the requirements of the regulations we inspected at the time.

Dearne Hall was registered on 29 July 2011. It is a care home registered for 48 people. Some people using the service have a diagnosis of dementia. On the day of our inspection, the home was fully occupied, with 48 people using the service.

It is a condition of registration with the Care Quality Commission that the service has a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. The registered manager was present on the day of our inspection.

We found the service ensured people were protected from abuse and followed adequate and effective safeguarding procedures. We found care records were personalised and contained relevant information for staff to provide person-centred care and support.

We found good practice in relation to decision making processes at the home and in line with the Mental Capacity code of practice, with the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards being followed.

There were issues around medicines at the home and medication administration records (MAR) not corresponding with stock checks we carried out. The registered manager was aware of these issues and had already started taking action to address this by speaking and working with a pharmacist and addressing staff training issues.

We found supervision of staff had not been carried out on a regular basis. The registered manager told us they were aware that this was an issue and had put actions in place to ensure regular supervisions were carried out in future.

There were good quality--monitoring systems in place at the home that were carried out on a monthly basis. We saw that, where issues had been identified, the registered manager had taken (or was taking) steps to address and resolve them.

We found several areas where staff required training or training updates. We spoke with the manager about this who told us they were aware of the need for more training at the home and would be looking into sourcing training from an outside organisation.

During our inspection, we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which has now been replaced with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

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

We spoke with eight people and seven relatives of people who lived at the home. We spoke with the registered manager and three care workers. We reviewed the care records of four people who lived at the home.

Where people did not have the capacity to consent, the provider acted in accordance with legal requirements. Observations showed that people were given choice and consent was sought from people for making decisions.

Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. Comments included, “It’s nice here, I’ve got a decent room with a good view and the staff are very helpful” and “I like living here. I’ve got a few friends and we have a laugh.”

People were protected from the risk of infection because appropriate guidance had been followed. Staff were trained in infection control and regular audits were undertaken.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The home had an appropriate recruitment procedure in place.

There was an effective complaints system available. People we spoke told us that if they ever did have a complaint they would speak to the manager, or one of the care workers. They felt complaints would be dealt with appropriately.

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 CQC inspector, joined by a practising professional and an ‘expert by experience’ (a person who has 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 with us.

People we spoke with told us that they liked living at the home and staff were very kind. One person said, “That if I paid over a £1000.00 a week I could not be any better looked after.”

During the SOFI and walking round the home we saw lots of examples where people moved about the home independently. For example, some people used their rooms as they wanted and some spent time in the communal areas.

We saw that staff had a caring approach to people and treated people with respect. For example, when people were asking to go to the toilet they were taken straight away. One person told us of an accident they’d had regarding continence and said “The staff were very reassuring to me.”

At lunch time there was a relaxed atmosphere and music was playing. We saw the menu with pictures that was displayed on the dining room wall to remind people of the choices available that day. We saw that people were offered their choice and were at liberty to change that choice if they wished. People were given a choice of where to have their meals.

We saw one person give a thumbs up sign for the meal they had eaten and one person say, “You’re a good cook you are” to a member of care staff.

We saw staff supporting people to eat their meals and saw that staff responded appropriately to meet the needs of people, spending time with them and encouraging them to eat. We saw that when people needed help to eat, the person was not rushed.

The food we saw served looked appetising, smelt nice and people had sufficient on their plates.

People we spoke with all felt they could talk to the manager and deputy manager with any concerns they had.

We saw that people interacted freely with staff and staff cared for them in a way that promoted people’s self esteem and individuality.

We saw that staff used an appropriate manner when communicating with people, respecting their needs and wishes.

We saw that staff had a caring and unhurried approach. For example, we saw staff taking people to the toilet before lunch, but they weren’t being rushed.

People told us there was only one male member of staff, but this did not pose a problem to the care provided.