This inspection took place on 26 and 28 November 2018 and was unannounced. When we last inspected Deneside Court in December 2017, we found the provider had breached the regulation relating to the safe management of medicines.

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, is the service safe, responsive and well-led, to at least good. During this inspection we found further concerns with the management of medicines and determined the provider was continuing to breach this regulation.

Deneside Court 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.

Deneside Court accommodates 41 people in one adapted building. There were 36 people living at the home when we inspected. They had a range of needs such as nursing, a learning disability and older people living with dementia.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

A new manager had been recruited shortly before our inspection. They were intending to register to become the registered manager. Since we visited the home, this application had been submitted for consideration. 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, relatives and staff told us the home was safe.

Staff showed a good understanding of the safeguarding and whistle blowing procedures operated at the home. They knew how to raise concerns and felt confident to do so if needed. The safeguarding log evidenced previous safeguarding concerns had been thoroughly investigated. However, we noted a statutory notification had not been submitted to the CQC for all safeguarding concerns as required.

Relatives and staff confirmed staffing levels had improved recently and the number of agency staff reduced. Staffing levels during our inspection were appropriate and the response to emergency calls was immediate. Staffing levels were monitored to check they were appropriate to meet people’s needs.

The provider continued to have effective recruitment checks to ensure new staff were suitable to work at the home.

Incidents and accidents were logged and analysed monthly.

Where risks to people’s safety had been identified, risk assessments had been carried out which identified measures to reduce the impact on people.

We identified issues with management about kitchen hygiene. For example, some food items were not stored safely and there was a poor state of overall cleanliness. Other areas of the home were clean.

Staff received good support and the training they needed for their caring role.

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 were supported to meet their nutritional and healthcare needs. People gave positive feedback about the meals provided. Where people has specific needs, these were met appropriately. Care records showed people had access to health professionals in line with their individual needs, such as GPs and community nurses. People also had access to support from an on-site therapy team including physiotherapists and occupational therapists.

People’s needs had be

This comprehensive inspection took place on 13 and 19 December 2017 and was unannounced. This meant the provider did not know we were coming.

Deneside Court 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. The service accommodated 40 people in a three storey building situated in its own grounds with an enclosed garden area.

We inspected Deneside Court in August 2016 and found the provider was not meeting six of the Regulations of the Health and Social Care Act 2008 (Regulated Activities).

We inspected the service again in January 2017 and found some improvements had been made, however the provider continued to breach four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities).

We inspected the service again in April 2017 and found improvements continued to be made at the service. However, the provider continued to breach two of the Regulations of the Health and Social Care Act 2008 (Regulated Activities). At that inspection we found medicines were not being managed safely. People were not receiving their medicines as prescribed. Medicine administration records were not always accurately signed. Stock balances were not always correct. Care plans relating to medicine were not always up to date.

The provider had failed to implement and embed improvements to enable sustained and significant improvements in medicine management. As a result conditions were imposed on the registration of the provider, at this location, to help drive improvements in the safe management of medicines. We checked to see if the provider was meeting the conditions as part of this inspection.

At this inspection we found the provider continued to breach Regulation 12 and 17 of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines continued to not be managed safely. Medicine administration records (MARs) were not always completed correctly. Handwritten entries of prescribed medicines found on MARs were not accurate and had not been signed by two members of staff. People were not receiving their medicines at the correct time. Care plans relating to medicine were not always up to date.

The provider’s quality assurance process in relation to medicine audits had failed to address the shortfalls regarding medicine management. This failure to appropriately audit this aspect of the service resulted in the provider not identifying the shortfalls that we identified during our inspection.

This meant the provider had failed to meet some of the conditions imposed on their registration. We will deal with this outside the inspection process.

The provider gave assurances that the areas of concern found at this inspection would be discussed with the manager and clinical lead to address the shortfalls.

The registered manager had recently left the service. 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 was being managed by a new manager. At the time of the inspection the manager had commenced their application to become the registered manager of Deneside Court.

We found staff were aware of safeguarding processes and knew how to raise concerns if they felt people were at risk of abuse or poor practice. Where lessons could be learnt from safeguarding concerns these were used to improve the service. Accidents and incidents were recorded and monitored as part of the provider’s audit process.

People received a holistic assessment prior to and on admission to the home. Information was used to work

This comprehensive inspection took place on 26 April 2017 and was unannounced. This meant the provider did not know we were coming.

Deneside Court is a 40 bed purpose built home and provides residential and nursing care to adults with learning disabilities and physical and neurological disabilities. At the time of the inspection there were 21 people using the service. The home is divided into three units. The ground floor unit comprises of 20 individual apartments with en-suite facilities. While the two upper units comprised of 20 self-contained flats containing kitchen facilities.

We had previously carried out a comprehensive inspection of Deneside Court on January 17 and 2 February 2017. At the inspection we found there were breaches of four of the Legal Requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines were not being managed safely. People were not receiving their medicines as prescribed. Medicine administration records were not always accurately signed. Stock balances were not always correct.

People’s emergency evacuation plans (PEEPS) were not up to date. Actions from recent fire audits seen at the last inspection had not been completed.

We found the registered provider was not always acting in accordance with the Mental Capacity Act in relation to people’s Lasting Power of Attorney (LPA).

Staff had not received regular supervision and appraisal. The registered provider had not checked the competencies of all new agency staff who formed part of the regular staffing team.

The provider had failed to implement and embed improvements to enable sustained and significant improvements.

At this inspection we found the provider continued to breach of Regulation 12 and 17 of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Medicines continued to not be managed safely. Medicine administration records (MARs) were not always completed correctly. Medicine stock balances were not accurately recorded. Handwritten entries of prescribed medicines found on MARs were not accurate and had not been signed by two members of staff. Medicine care plans were not updated when changes in medicines were prescribed. The provider’s quality assurance process had failed to address the shortfalls regarding medicine management. This meant we could not be assured that people received their medicines as prescribed by their doctor.

We have judged that this has a moderate impact on people who use the service. This is being followed up and we will report on any action when it is complete.

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 2008 and associated Regulations about how the service is run.

The service was being managed by a peripatetic manager. At the time of the inspection the manager had submitted an application to become the registered manager of Deneside Court.

Recruitment procedures were thorough and all necessary checks were made before new staff commenced employment. For example, two references and disclosure and barring service checks (DBS). These were carried out before potential staff were employed to confirm whether applicants had a criminal record and were barred from working with vulnerable people.

Environmental risks were assessed and reviewed to ensure safe working practices for staff, for example, to prevent slips, trips and falls. Where people had been assessed at being at risk, plans were in place for staff for support and guidance to mitigate risks.

Policies and procedures were in place for safeguarding and whistleblowing which were accessible to staff for support and guidance. We found staff had received training in safeguarding. We found staff

This comprehensive inspection took place on 17 January and 2 February 2017.

Deneside Court is a 40 bed purpose built home and provides residential and nursing care to adults with learning disabilities and physical and neurological disabilities. At the time of the inspection there were 28 people using the service. The home was divided into three units. The ground floor unit comprises of 20 individual apartments with en-suite facilities. While the two upper units comprise of 20 self-contained flats which each contained kitchen facilities.

We had previously carried out a comprehensive inspection of Deneside Court on 28 July followed by 29 July, 4 and 11 August 2016 following concerns raised by external health and social care professionals and the police. At the inspection we found there were breaches of six of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We identified multiple concerns in respect of the safe care and treatment of people using the service. The registered provider failed to provide safe management of medicines. Staffing levels were insufficient to meet the assessed needs of people using the service. The registered provider’s recruitment process did not cover the reviewing or checking of agency staff’s clinical competencies or training. People's health and nutritional needs were not being met in a safe manner. The registered provider did not ensure staff received appropriate training and development to enable them to carry out the duties they were employed to perform.

The registered provider was not following the principles of the Mental Capacity Act 2005, no records of best interest discussions were available. Staff were not aware of people who were subject to a Deprivation of Liberty safeguard. Care records did not reflect people's needs and preferences. The registered provider did not have effective quality assurance processes to monitor the quality and safety of the service provided and failed to ensure that people received appropriate care and support.

We undertook this comprehensive inspection to check that the registered provider now met legal requirements. During this inspection we found the registered provider had implemented actions and some improvements had been made. However, we found the registered provider continued to breach four of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

An inspection of the registered provider’s management of medicines procedures was undertaken by two pharmacy inspectors. Medicines were not managed safely. People’s records were not clear to demonstrate that medicines were administered. The stock balance of medicines was not accurate. Care plans relating to medicine administration had not been reviewed. Where people were prescribed as and when medicines, protocols for their administrating were not up to date. Prescribed medicines were not being administered in line with the GP prescription. The ordering system used for ordering medicines was not effective. Medicines were being used that were past their use by date. Keys for the excess stock cupboards and refrigerators were left unattended in the locks. Temperature recording of the refrigerator used to store medicines was not being consistently recorded.

People’s emergency evacuation plans (PEEPS) were not up to date, putting people at risk in the event of an emergency. Actions from recent fire audits seen at the last inspection had not been completed.

We found the registered provider was not always acting in accordance with the Mental Capacity Act in relation to people’s Lasting Power of Attorney. The registered provider was not always aware of people’s arrangements for decision making and seeking consent.

Staff had not received regular supervision and appraisal. The registered provider had not checked the competencies of all new agency staff who formed part of the regular staffing team.

We

We carried out this comprehensive inspection of Deneside Court on 28 July followed by 29 July, 4 and 11 August 2016. The first three days of the inspection were unannounced which meant that staff and the registered provider did not know we were visiting.

We had previously carried out a focused inspection of Deneside Court in March 2016 following concerns raised by external health and social care professionals and the police. During the inspection a breach in one of the legal requirements was found. The provider had failed to take appropriate steps to ensure staff were trained to provide safe and effective care to people at all times.

We asked the registered provider to send us an action plan outlining what steps they would take to ensure the home complied with Regulation 18 (Staffing) of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They told us the actions would be completed by 30 June 2016. We took this action plan into consideration during this inspection.

The service does not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 does have a manager who is new to post. They told us they intended to submit an application for registration with the Commission. The manager was being supported in the service by the area manager.

At this inspection we found that there were breaches of six of the Fundamental Standards of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, consent, safeguarding, staffing recruitment and the overall oversight of the home.

Deneside Court is a 40 bed purpose built home and provides residential and nursing care to adults with learning disabilities and physical and neurological disabilities. At the time of the inspection there were 36 people using the service. The home was divided into three units. The ground floor unit comprises of 20 individual apartments with ensuite facilities. While the two upper units comprise of 20 self-contained flats which each contained kitchen facilities.

In addition to the above dates two pharmacy inspectors visited the service on 1 August 2016. This was to enable a full inspection of the registered provider’s management of medicines procedures as we found the oversight and management of medicines was not safe. There were errors in the administration of medicines. Records for stock balances were not accurate. Medicines were being used that were past their use by date. Emergency medicines were not available for people who may have required emergency administration. Although we found medication audits which identified issues the registered provider had failed to action these.

People’s risk assessments were generic and risks associated with people’s conditions for example, epilepsy, were not considered. Risk assessments were not subject to review in line with the changing needs of people or in line with the provider’s own prescribed timescales.

Staff did not always have the appropriate training and skills to meet the needs of the people living in the service. For example, diabetes, learning disabilities and mental health needs. There was a lack of suitably skilled and experienced nursing and care staff permanently employed and the registered provider relied on temporary agency staff to provide nursing care and support on a day to day basis. They had failed to check that agency nursing staff had the skills and competencies to deliver the care and treatment people needed, such as tracheostomy care and su

We carried out an unannounced comprehensive inspection of this service on 17 November 2015. We undertook this unannounced focused inspection on 21 March 2016 to check the safety of people who used the service as CQC had received a number of statutory notifications, since the last inspection, where police had been involved in incidents that had taken place with people who used the service. Notifications are changes, events or incidents the provider is legally obliged to send CQC within required timescales.

Deneside Court is a care home providing accommodation with nursing and personal care for up to 40 people with learning disabilities, physical and neurological disabilities. The home is divided into five units which comprises 25 individual bedrooms with en-suite facilities over three units and two units consisting of 15 self-contained flats with kitchen facilities. A registered manager was in post at the time of the 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.

We found the provider had identified in most cases where improvements were required to keep people safe. However some arrangements had been not put in place in a timely way to keep people safe.

Staff had not received all the training they needed to do their job effectively and to ensure the safety of people who used the service.

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

This report only covers our findings in relation to those legal requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Deneside Court on our website at www.cqc.org.uk.

The inspection took place on 17 November 2015. This inspection was unannounced. The last inspection of this home was carried out on 21 and 28 January 2015.

At the last inspection we found the provider was not meeting two of the regulations we inspected.

We found the provider did not have accurate records in place to demonstrate safe administration of medicines and the provider did not maintain accurate records to protect people from the risk of unsafe or inappropriate care and treatment. An action plan was received from the registered provider following the last inspection which took place in January 2015, which stated the service would meet the legal requirements by 30 June 2015.

We found there had been improvements to care planning, risk assessment and people involvement. We could see good evidence that the action plan which had been formulated to improve the management of medicines had been implemented effectively. However we found some small inconsistencies where fridge and room temperatures were not recorded effectively and the recording of refusal of medicine was also inconsistent. The registered manager was made aware of this at the time of the inspection and was continuing to drive improvement in both of these areas.

Deneside Court is a 40 bed purpose built home and provides residential and nursing care to adults with learning disabilities and physical and neurological disabilities. At the time of the inspection there were 36 people using the service.

The home was divided into three units. The ground floor unit comprises of 20 individual apartments with ensuite facilities. Whilst the two upper units comprises of 20 self-contained flats which contained kitchen facilities.

The home had a registered manager. A registered manager is a person who had registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have a legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We saw that care records contained care plans and assessments pertaining to health and well-being, these were individualised depending on need. One relative told us, “I am involved in care planning, the home always contact me when there is something to discuss.”

People were actively supported to access the community. The home arranged for people to visit community health services as part of their daily living skills. One relative told us, “[family member] gets involved in activities, enjoys the baking and goes in the hydrotherapy pool when they are feeling well enough and are able.”

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people were not restricted unnecessarily.

One relative we spoke to told us, “Staff are very patient with [family member].” We saw that staff supported people and we saw caring interventions. Staff told us that they observe people’s body language and facial expressions to support their communication.

Staff told us the management was approachable and would listen to the concerns of staff, arrangements were in place to leave secure messages for the registered manager. We found that the home recognised the importance of maintaining religious and cultural beliefs by making specific arrangements to create a place of worship in the home.

One visiting health care professional told us, “Staff are quick to contact me, they are knowledgeable and always take note of my advice and act on it.”

Recruitment practices at the service were thorough, appropriate and safe. Only suitable people were employed. Staff training was up to date and staff received supervision and appraisals. Staff received an induction in the home and received a probationary review to discuss their development. Training was provided that meet the needs of the people who used the service.

Relatives told us that their family members had the correct levels of well trained staff supporting them in the home and in the community. We reviewed the most recent and historical rotas. There were two qualified nurses on duty during the day and one at night. In addition between Monday and Friday the registered manager and deputy manager were both on shift and were both qualified nurses. There were also sufficient support workers employed to meet the needs of the people who used the service.

We saw that the service assessed peoples’ nutritional needs and had developed a varied menu. People told us, “The food looks very good – not fancy – but good and wholesome.”

We considered all the evidence we gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service caring?

• Is the service responsive?

• Is the service safe?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found –

Is the service safe?

Some aspects of this service were not safe. We found there were insufficient numbers of suitable staff to ensure people were supervised and appropriately stimulated and engaged. We saw that people who required one to one assistance had their support interrupted as staff had to also see to other people’s needs at the same time. Additionally, some people were unable to engage in activities away from the home due to staff shortages on the day of our visit. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The person in charge told us that 14 applications in relation to DoLS had been submitted.

The provider assessed people, using recognised tools, against the risks of poor nutrition and skin damage.

Is the service effective?

Some aspects of the service were not effective. People had their needs assessed and most staff understood what people’s care needs were. However, care plans were often not updated. Although staff had received some relevant training, this was out of date and incomplete, which meant people were at risk of not having their needs met.

We viewed the care records for five of the 33 people who used the service. These confirmed that people, or relative’s on their behalf, had not been asked to give their agreement to the care plans. We saw examples of other formal consent, such as for sharing information and using people’s photographs. Information gathered during the initial assessment was used to develop people’s care plans. We found care plans identified specific aims and objectives for people, however they did not have regular reviews of their assessed needs and staff did not have up to date information to help them completely understand people’s care needs. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements of the law in relation the maintenance of accurate records.

Is the service caring?

We found that staff interacted positively with people and were kind and caring. However, we found people were left for long periods of time without interaction from staff to ensure they were appropriately stimulated and engaged. This was because of staff shortages and the fact that staff were busy meeting the needs of the people who required one to one assistance. We observed care being delivered throughout our inspection and undertook specific observations over a lunch time and in the lounge area. We found that people had to wait an unreasonable time to be assisted, which impacted on their wellbeing.

People who used the service and their family members all gave positive feedback about the service and the staff members who delivered the care. Some people and family members said more staff were needed. People commented: “Yes I get good care” and, “I can easily get in touch with staff, very likeable people.” Family member’s comments included, “The carers are lovely, I cannot fault it”; my relative gets well cared for”.

Is the service responsive?

Some aspects of the service were not responsive. We found that due to insufficient staffing levels some people did not always have the support they needed to ensure they had their needs met in a timely manner. We saw examples within people’s care records of action taken to respond to people’s changing needs, such as referring people to specialists; including specialist nurses, and occupational therapist. However care plans were not being evaluated regularly to ensure they remained up to date and reflected people’s current needs. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

Is the service well-led?

The service was not well-led. We found reviews of staffing levels were inconsistent and ineffective to assess the impact on the safety and welfare of people who used the service. The analysis undertaken looked at staffing levels as a whole across the home and did not take account of how staff had been deployed. For example, the analysis did not consider dependency levels on the separate units and the need to carry out laundering duties. It also did not take account of particular pressure points throughout the day, such as meal-times and taking people out in the community.

The provider undertook regular audits to check the quality of service. However, we found the quality checks undertaken were infrequent and subsequent action plans not followed up to address gaps in record keeping. We have set a compliance action and asked the provider to tell us what they are going to do to meet the requirements in relation to the effective operations of systems to monitor the quality of services provided.

We carried out an unannounced visit following concerns made known to the Care Quality Commission (CQC) about how Deneside Court were taking in paying guests to help with its running costs. We spoke with the acting manager and the compliance manager for Careline Lifestyles (UK) Limited. They told us with the exception of residents in the home they have no one paying for overnight accommodation staying at Deneside Court. Staff were seen to interact well with people and knew them by their first name.

This review was carried out to check improvements made to the service's procedures about infection prevention control following our previous visit in June 2013. We spoke with some people during the day who were sitting in the lounge. They told us they were happy with the service provided by the staff.

People had been individually assessed to see if they could make their own decisions. Care records had enough information so staff would be able to know how to support each person in the right way.

During this inspection we checked the issues relating to the environment which had previously raised concerns. Although some issues had been addressed, we found we had some further concerns regarding the laundry area which we have asked the provider to review.

We saw on the day of our visit, there were sufficient qualified, skilled and experienced staff to meet people’s needs. The provider had a system for checking the quality and safety of the service and records were maintained and held securely. Surveys were also carried out. The records of these processes were up to date which provided feedback to the manager and staff members regarding information they needed to run the home effectively.

People who were able told us they were happy with the quality of their care, and told us they felt relaxed and content in the home. People in the home were protected from abuse. Staff were aware of their responsibilities to keep people safe, and told us they would report any bad practice. People told us they felt safe and protected by the staff who, they said, "Were kind and caring". Staff had been fully supported in meeting people's needs because they received regular supervision or appraisal, and training was up to date.

The home had systems in place to regularly check the quality of the care and other services such as catering, the environment and fire safety. Actions had been taken where problems had been identified.

We did have some concerns regarding the absence of hand wash basins in the laundry or servery areas which we have asked the provider to review.

We carried out this unannounced inspection over two days, on 21 and 28 January 2015.

At the last inspection we found the provider was not meeting all of the regulations we inspected. We found there were not enough qualified, skilled and experienced staff to meet people’s needs, staff did not always receive appropriate training and suitable appraisal and supervision, and the systems the provider had in place to monitor the quality of service people received were not effective or undertaken on a regular basis. An action plan was received from the provider which stated they would meet the legal requirements by 31 December 2014. At this inspection we found improvements had been made and previous breaches of regulations and actions we asked the provider to take had been addressed, however there were two new breaches of regulations identified.

Deneside Court is a 40 bed purpose built home and provides residential and nursing care to adults with learning disabilities and physical and neurological disabilities. It has six separate units with two units on the ground floor, two units on the first floor and another two units on the second floor. Additional facilities include a hydrotherapy pool, kitchen, cafe bar, meeting rooms and access to a sensory garden. At the time of our inspection 35 beds were occupied, of which 20 were located on the ground floor and 15 were located on the upper floors.

The home had a registered manager who had been in post since January 2013. 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.

Previously identified breaches of regulations had led to necessary improvements. We found there had been an increase in the number of staff on each shift from the previous inspection in August 2014. A deputy manager had been appointed and would be starting at Deneside Court at the end of February 2015. People at the home, their friends and relatives told us there were some previous occasions when there were not enough staff on duty.

Staff had been receiving regular supervision and appraisals, and the current systems to regularly assess and monitor the quality of services were effective. However additional breaches of the regulations were also identified during the course of this inspection. We found the recording of people’s medicines was not managed safely as we found some medicine records were inaccurate and did not support the safe administration of medicines. We also found monthly weight charts had been inconsistently completed, and there were gaps in the risk assessment support plans.

People and their relatives told us staff treated people with kindness. We saw caring interactions between people and staff and there was a friendly atmosphere around the home. People told us they enjoyed the meals at the home although one relative told us that the standard of meals had dropped since the chef was promoted within the company. Recruitment practices at the service were thorough, appropriate and safe. Staff told us morale had improved following the manager’s return to the home. All of the staff we spoke with felt the manager was supportive and approachable.

Relatives we spoke with told us, “There have been some issues with my son’s care but now I feel the place is on the up.” Another relative told us, “Staff are really good with my [relative], which is all that matters”. “We have had some concerns in the past but feel confident now the manager is back”.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we have told the provider to take at the back of the full version of this report.