About the service: Devonshire House is a residential care home providing personal care for up to 69 people. On the day of our visit there were 48 people resident in total. There were 25 people living on Ryder unit. This is a specialised unit with adapted facilities for people living with dementia.

People’s experience of using this service:

We found that developments had taken place and people were now provided with better overall outcomes. The three beaches in regulation found at the last inspection had all been systematically addressed. People at this service were now provided with a more caring, consistent, responsive service that was being effectively managed through a period of change.

• The management of medicines was not always effective and sometimes placed people at risk of harm.

• Staffing remained a challenge but was safe with sufficient, appropriately trained staff supplied and people’s needs were met consistently.

• Risks associated with people's care were identified and staff knew how to manage them to keep people safe.

• People, relatives and staff were consulted and involved about changes made and those planned.

• People’s feedback was consistently positive about the care, support and staff. One person told us, “I am undoubtedly treated with dignity and respect. They are kind and caring to everyone. They are very nice and do whatever you ask.” A relative told us, “I have never come across anything that was not perfectly proper. They go above and beyond.”

• People using the service were relaxed with staff and the way staff interacted with people had a positive effect on their well-being.

For more details please see the full report which is on the CQC website www.cqc.org.uk

Rating at last inspection: We rated Devonshire House as requires improvement and published our report on 8 March 2018.

Why we inspected: Previously we had rated this service as requires improvement and therefore have been back to check that it had improved to good. We had received an action plan telling us what the service managers would do to become compliant and therefore we checked this action had been taken.

Follow up: Going forward we will continue to monitor this service and plan to inspect in line with our reinspection schedule for those services rated good.

This unannounced inspection took place on 27 November 2017. This was the first comprehensive inspection of this location since Anchor Trust became registered as the provider of this service on 09 February 2017.

Devonshire House 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. Devonshire House is registered to accommodate up to 69 people. On the day of our visit there were 58 people resident. There were 21 people living on Ryder unit. This is a specialised unit with adapted facilities for people living with dementia.

At CQC we have a named registered manager on records, but had been informed that the registered manager no longer worked at the service. We await an application for them to deregister. 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.

Devonshire House is a relatively new acquisition for Anchor Trust and this along with the changes in management mean they need to develop a clear vision and credible strategy to deliver high quality care and support at Devonshire House that involves all stakeholders. The lack of consistent quality leadership has led to the breaches found at this inspection.

We found three breaches in the regulations. Risks to people’s safety and welfare were not robustly assessed. This was particularly in relation to supporting people with distressed behaviour that were living with dementia and also falls prevention. We observed altercations between people that went unnoticed and had potential to escalate. Guidance for staff was not clear to minimise risks and promote people’s safety.

There were insufficient staff deployed consistently to meet people’s needs. Managers at the service did not have oversight as to where people were within the service and how many staff were deployed and where they were working. There were examples particularly on Ryder unit where people were not supported appropriately. There were gaps in past the rosters despite managers using dependency tools to determine staffing.

The complaint systems in place did not effectively address people’s concerns raised nor were they used to drive improvements. People were not supported by the provider to raise concerns when necessary. We found responses to concerns raised were not robust or individualised.

Overall the service people received was inconsistent. There was a lack of involvement of people in how the service was run therefore matters such as activities on offer and planning for end of life care needed further development. Anchor Trust had recognised these shortfalls for themselves and had started to action some points. Additional management support had been drafted in. There were consultations in place about the development of the environment. Environmentally this was a pleasant place for people to live, but the Ryder unit needed development to enhance the experiences for people living with dementia.

Staff supporting people were caring and compassionate. They were dedicated and willing to support people the best way they could. Staff on the Ryder unit would benefit from enhanced training in dementia. People did receive access to good health care and had sufficient to eat and drink. Staff promoted choices and independence for people.

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