About the service: • Erskine Hall Care Home provides accommodation and personal care, including nursing care, to older people. The care home accommodates up to 80 people in one adapted building. At the time of the inspection 47 people were living there. This was because the home was ongoing refurbishment so not all of the bedrooms could be occupied.

People’s experience of using this service:

• Since our last inspection the service had made improvements. However, there were still areas that required improvement.

• People liked living at the service and got on well with staff who knew them well.

• People were able to choose how to spend their time and were encouraged to make decisions about their care. However, these were not always clearly documented in relation to people’s capacity to make informed decisions.

• People told us they had enough to do and enjoyed the activities available.

• People told us were supported by enough staff and told us they felt their needs were met.

• People did not have individual risk assessments in many cases. As a result, there was a potential for unsafe care to be delivered.

• The provider had systems in place to provide good quality care and ensure staff were trained.

• The registered manager had started just shortly before the last inspection and people and staff were positive about them. They told us that he had made a difference to the home.

• The service met the characteristics for a rating of "Requires improvement" in four key questions and met the characteristics for a rating “Good” in one key question.

• More information about our inspection findings is in the full report.

Rating at last inspection: At our last inspection the service was rated as requires improvement.

Why we inspected:

• All services rated "requires improvement" are re-inspected within one year of our previously published inspection report.

• This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up: We will continue to monitor the service to ensure it provides safe and effective care. We will plan further inspections in the future.

This comprehensive inspection took place on 23 and 24 November 2017 and was unannounced.

Erskine Hall Care Home 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.

Erskine Hall Care Home accommodates up to 85 people in one purpose built building. At the time of our inspection there were 46 people living at the service.

At our last inspection in November 2016, the service was rated Requires Improvement.

At this inspection, the service remains rated Requires Improvement.

The service had a registered manager however they were no longer in post. A new manager had been appointed and had been in post for a period of six weeks. 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.

Quality assurance systems had not been consistently implemented to evaluate and monitor the quality of the service. However, since commencing work at the service the manager had completed a range of quality monitoring audits and these were being used to identify where actions needed to be taken to drive improvements in the service. Feedback on the service was encouraged and acted upon.

A potential safeguarding concern had not been referred to local authorities. Staff told us they understood their responsibilities with regards to safeguarding people and they had received training.

People felt safe and secure in the service. There were personalised risk assessments in place that offered guidance to staff on how individual risks to people could be minimised. Medicines were stored appropriately, managed safely and audits completed.

There were consistent numbers of staff on duty to meet people's needs however people told us that they experienced some delays in receiving their care. Robust recruitment processes were in place and the required recruitment checks had been completed to ensure that staff were suitable for the role they had been appointed to prior to commencing work.

Staff received training to ensure they had the skills and knowledge to support the people living in the service. Staff felt supported in their roles and received regular supervision. New members of staff received an induction. Staff were positive about the training they received.

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 had been in involved in deciding the way in which they wished to receive care. People’s consent was gained before any care was provided.

A varied, balanced diet was offered at the service and people were complimentary about the meals provided to them. People's health care needs were being met and they received support from health and medical professionals, when required.

People and their relatives spoke positively about staff. They told us that staff were caring, kind and respectful. People's privacy and dignity was promoted throughout their care.

People’s needs had been assessed prior to their admission to the service. Care plans took account of people’s individual needs, preferences and choices and had been regularly reviewed.

People were encouraged and supported to participate in a range of activities and received relevant information regarding the services available to them.

There was an effective complaints system in place. People and staff knew who to raise concerns with and there was clear line of accountability amongst senior staff.

People, relatives and staff spoke positively about the manager. The management team

This unannounced inspection took place on 2, 3 and 15 November 2016. We visited the service on 2 and 3 November 2016, and completed the inspection on 15 November 2016 when we received feedback from a professional we had contacted.

The service provides care and treatment to older people with chronic health conditions, physical disabilities, and those who require palliative or end of life care. At the time of the inspection, 62 people were being supported by the service.

When we inspected the service in October 2015, we found staff training was not up to date, food and fluid charts were not always completed fully to evidence that people were eating and drinking enough. Also, wound care was not always evidenced in people’s care records. Although we found improvements had been made to staff training during this inspection, staff were still not always keeping up to date records of what support they had provided to people. However, we saw that the manager had put processes in place to improve this.

There was no registered manager in post, but a manager who had been in post since June 2016 had started the process to register with the Care Quality Commission. 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 provider had effective systems in place to safeguard people and staff had received safeguarding training. There were individual risk assessments that gave guidance to staff on how risks to people could be minimised. People’s medicines had not always been managed safely, but improvements had been made in the medicine management systems to ensure that people received effective treatment.

The provider had effective recruitment processes in place, but people did not feel that there was always sufficient staff to support them safely. More staff had been recruited so that a consistent group provided continuity of care. The manager and staff understood their roles and responsibilities in ensuring that people’s care was provided in accordance with the requirements of the Mental Capacity Act 2005 (MCA) and the associated Deprivation of Liberty Safeguards (DoLS). Staff training was now up to date. Staff were supported in the form of supervision and team meetings that enabled them to provide appropriate care to people who used the service.

Although people’s needs had been assessed and they had care plans that took account of their individual needs, preferences and choices, people had not always been supported quickly when they rang their call bells. However, the manager has put processes in place to improve this. People were supported to have sufficient food and drinks, and had access to health services when required in order to maintain their health and wellbeing.

Staff were kind and caring towards people they supported. They treated people with respect and supported them to maintain their independence as much as possible. A variety of activities had been provided to occupy people within the home and people had been given opportunities to pursue their hobbies and interests outside of the home.

The provider had a formal process for handling complaints and they responded quickly to people’s concerns. They encouraged feedback from people and their relatives, and acted on the comments received to improve the quality of the service.

Although the manager and other senior staff provided support to staff, some staff did not feel that they worked well together as a cohesive team. The manager regularly assessed and monitored the quality of the service provided, but more work was required to ensure that they provided consistently safe and effective care that met people’s needs and expectations.

People we spoke with said that there privacy and dignity was upheld. People also told us that they were happy residing at the home and were mostly happy with the care they received. One person said “there are some really, really good staff” and “I have settled nicely”. However people also felt that the home sometimes had ‘lots’ of agency staff that did not know them well.

During our inspection we observed that medication was not given to people at the required time. The home had a robust recruitment system in place which ensured that staff were qualified and suitable to provide care to people who resided in the home. We saw that the home had some systems in place to check the quality of the service they provided

During our follow up visit to this service, people who used this service told us that the quality of care had improved in recent months. People said there appeared to be more staff on duty, and more activities were now provided. We observed staff assisting people in an effective, considerate and unhurried manner. We noted that when a call bell rang, staff usually responded immediately, and if the care staff were unable to respond straight away they explained to the person that they would be with them in as soon as possible.

People looked clean and smart. The people we spoke with and their relatives confirmed that the personal care they needed, had been provided that morning. They confirmed that care was provided in a timely way, apart from ‘the odd blip which was to be expected’. We observed people having their lunch, and noted there was a choice of food, and weekly and daily menus were displayed.

People told us they liked having company around them, but there were some issues that people were not happy about.

People using the service told us that generally they were happy with the care, treatment and support they received. They were complimentary of staff and felt that their health and welfare needs were being met. They also said that they are confident about raising any concerns and that their views were listened to and acted upon.

This inspection took place on 14 and 15 October 2015 and was unannounced. The service provides accommodation, personal and nursing care for up to 85 older people. On the day of the inspection, there were 76 people living in the home.

The service is required to 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 manager took up their post in June 2015 and was not yet registered with the commission. They were awaiting for their application for registration to be processed.

People were safe and there were systems in place to safeguard them from the possible risk of harm. There were risk assessments that gave guidance to staff on how risks to people could be minimised. Risks to each person had been assessed and managed appropriately.

The service followed safe recruitment procedures and there were sufficient numbers of suitable staff to keep people safe and meet their needs. There were safe systems for the management of people’s medicines and they received their medicines regularly and on time.

People were supported by staff who were trained, skilled and knowledgeable on how to meet their individual needs. Staff received supervision and support, and were competent in their roles.

Staff were aware of how to support people who lacked mental capacity to make decisions for themselves and had received training in Mental Capacity Act (2005) and the associated Deprivation of Liberty Safeguards. People at risk of not eating and drinking enough were not always effectively monitored. People were supported to access other health and social care services when required, but there was not always sufficient information to ensure that their health care needs were appropriately met.

People were treated with respect and their privacy and dignity was promoted. People were involved in decisions about their care and support they received.

People had their care needs assessed, reviewed and delivered in a way that mattered to them. They were supported to pursue their social interests and hobbies and to participate in activities provided at the home. There was an effective complaints procedure in place.

There were systems in place to seek the views of people, their relatives and other stakeholders. Regular checks and audits relating to the quality of service delivery were carried out. There were effective systems in place to monitor the quality of the service.