Emberbrook is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Emberbrook accommodates up to 68 people in one adapted building. The building is arranged into four units, over two floors each with their own lounge and dining rooms.

At the time of our unannounced inspection on 24 October 2018 there were 60 older people living at the home, many of whom were living with dementia.

There was not a registered manager in place. 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 been without a registered manager since December 2017. A new manager had commenced in post in August 2018 and was applying to become registered.

We last inspected Emberbook in July 2017 when we rated the service as Requires Improvement. This was because we found shortfalls in staff deployment, following the principals of the Mental Capacity Act, records and governance. There was a breach of Regulation 11 in relation to obtaining people’s consent. Following that inspection, the provider sent us an action plan telling us how and when they planned to meet the regulations. We checked at this inspection whether or not they had followed their action plan and we found they had improved in some areas, but there were shortfalls in others.

The service had been without a registered manager since December 2017. A new manager had commenced in post, but resigned after four months. During the time without a registered manager the registered provider had failed to ensure there was robust management oversight of the service. This has resulted in a people receiving a level of service less than they should expect.

People were living in a service that had insufficient staff to care for them and risks to people were not always addressed or recorded in a way that gave guidance to staff. We also observed poor moving and handling practices. Medicines management processes did not follow good practice. Where people lived with dementia the environment was not adapted for their needs. There was a lack of signposting or aids to orientate people. The service was clean.

Although people’s needs were assessed before moving into the service. People had care plans in place which gave detailed guidance in many areas of their care needs, but writing was very difficult to read and people’s background histories had not been obtained to help staff get to know people.

People were cared for by staff who did not always show them respect or respond to them in a caring way. People were not always given a choice of the meal they would like to eat, although we did see people were provided with sufficient food and drink.

Accidents and incidents were recorded but not routinely analysed and although staff knew what to do in the event of a concern of abuse, paperwork in relation to reporting concerns could not be found. People’s consent was sought before care commenced. Although we found an improvement in ensure the principals of the MCA were followed, there was further work to be done.

People were cared for by staff who had been recruited through a robust process. Staff had received induction and training for their role, however regular supervision, including clinical supervision, did not always happen.

Records relating to the service prior to the manager’s appointment were difficult to find. There was a lack of complaints and audit information. However, the manager could access information we requested of them on the day.

People had access to activities both within and external to the service. However, there

Emberbrook Care Home is a nursing home that is registered to provide accommodation for up to 68 people who may require nursing or personal care. Some people who reside in the home may be living with dementia. The service has four units arranged over two floors and each person has their own bathroom. On the day of our inspection there were 61 people living in the service.

This is the first inspection of the service since it was newly registered with CQC in August 2016 under a different provider. We had previously inspected the service under the old provider and identified that some improvements were needed. We checked to make sure that action had been taken and improvements had been made.

There was a registered manager in post. 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’s human rights were not always protected as the provider had not ensured that the requirements of the Mental Capacity Act 2005 were followed. Where people were assessed to lack capacity to make some decisions, some mental capacity assessments and best interests decisions had not been completed. The registered manager had not always ensured that relatives making decisions on people’s behalf had the legal authority to do so. Staff were heard to ask peoples consent before they provided care

Where people’s liberty may be restricted to keep them safe, the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS) to ensure the person’s rights were protected. Applications had been made to the local authority.

There were sufficient staff to keep people safe. However, we have made a recommendation to review staffing levels at break times. There were recruitment practices in place to ensure that staff were safe to work with people. There were plans in place to ensure people received care should there be an emergency.

Staff had written information about risks to people and how to manage these. Risk assessments were in place for a variety of areas such as falls and moving and handling. The registered manager ensured that actions had been taken after incidents and accidents occurred to reduce the likelihood of them happening again.

People were protected from avoidable harm. Staff received training in safeguarding adults and were able to demonstrate that they knew the procedures to follow should they have any concerns.

People had sufficient to eat and drink. People were offered a choice of what they would like to eat and drink. People’s weights were monitored on a regular basis to ensure that people remained healthy.

People were supported to maintain their health and well-being. People had regular access to health and social care professionals.

Staff were trained and had sufficient skills and knowledge to support people effectively. Staff received regular supervision and an annual appraisal.

People were well cared for and positive relationships had been established between people and staff. Staff interacted with people in a kind and caring manner.

Relatives, people and health professionals were involved in planning people’s care. People’s choices and views were respected by staff. Staff and the management knew people’s choices and preferences. People’s privacy and dignity was respected.

People received a personalised service. Care plans contained information for staff to support people effectively, however they needed to be more personalised. The registered manager had identified this and work was progressing to improve this. People told us that there were enough activities and there was a good choice.

The home listened to staff, people and relative’s views. There was a complaints procedure in place. Complaints had been responded t