The inspection took place on 24 July 2018 and was unannounced.

Fosse House 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

Fosse House is a care home without nursing registered to provide accommodation and personal care for up to 81 older people. At the time of this inspection 76 people were accommodated at Fosse House.

The home had a registered manager. 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.

When we last inspected the service in June 2016 the service was rated as Good. At this inspection we found that standards had been maintained and in one area further improvements had been made to provide outstanding experiences for people who lived at Fosse House. The staff team had worked tirelessly to provide people with excellent opportunities to enjoy personalised activities and outings as well as experience new things that they had only ever dreamt of previously. The registered manager and staff team demonstrated a 'can do' attitude to ensuring people enjoyed opportunities for engagement and stimulation. The provider had arrangements to receive feedback from people who used the service, their relatives, external stakeholders and staff members about the services provided. People were confident to raise anything that concerned them with staff or management and were satisfied that they would be listened to.

People felt safe living at Fosse House. Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed. The home was calm and people's needs were met in a timely manner by sufficient numbers of skilled and experienced staff. The provider operated robust recruitment processes which helped to ensure that staff employed to provide care and support for people were fit to do so. People's medicines were managed safely.

Staff received regular one to one supervision from a member of the management team which made them feel supported and valued. People received the support they needed to eat and drink sufficient quantities and their health needs were well catered for with appropriate referrals made to external health professionals when needed.

People and their relatives complimented the staff team for being kind and caring. Staff were knowledgeable about individuals' care and support needs and preferences and people had been involved in the planning of their care where they were able. Visitors to the home were encouraged at any time of the day.

There was an open and respectful culture in the home and people, their relatives and the staff team were comfortable to speak with the registered manager if they had a concern. The provider had arrangements to regularly monitor health and safety and the quality of the care and support provided for people who used the service.

The inspection took place on 23 June 2016 and was unannounced. At our last inspection on 18 June 2015 we found that the service was not meeting the required standards in some of the areas we looked at. There were not always sufficient numbers of staff to meet people’s needs, risks to people’s health were not mitigated effectively, people were not supported to take their medicines safely, consent was not always obtained in accordance with the Mental Capacity Act 2005 (MCA) and the systems used to monitor risks and quality assure services were not effective. At this inspection we found that the improvements required had been made and that the service was meeting the fundamental standards.

Fosse House is a purpose built residential care home. It provides accommodation and personal care for up to 81 older people, some of whom live with dementia. The home is comprised of residential, dementia care and enablement units spread over two floors where staff provide care and support for people with varying needs and levels of dependency. At the time of our inspection there were 78 people living at the home.

There is a manager in post who is in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

Robust and effective recruitment processes were used to ensure that all staff employed at the service were of good character and had the skills, abilities and experience necessary to do their jobs.

There were sufficient numbers of staff available who were deployed in a consistent and effective way across the home. Staffing arrangements reflected and took account of people’s individual needs and levels of dependency which meant that care and support was provided in a calm and patient way.

People told us they felt safe at the home. Staff received training in how to safeguard people against the risks of abuse and knew how to report any concerns they had, both internally and externally if the need arose.

Appropriate steps were taken to ensure that identified risks to people’s health, safety and well-being were mitigated in a safe and effective way that promoted their independence. Accidents, falls and injuries were recorded and investigated thoroughly to identify emerging risks, patterns and trends.

Medicines were stored, administered and managed safely. People were supported by trained staff to take their medicines on time and in accordance with prescriber’s instructions.

Plans and guidance were in place to help staff deal with unforeseen events and emergencies. Fire and other safety equipment was checked and tested regularly to keep people safe. Personal evacuation plans, tailored to people’s individual health and mobility needs, were in place for everybody who lived at the home.

Staff obtained people’s consent before providing the day- to- day care and support they required.

The service acted in accordance with the requirements of the MCA 2005 where appropriate and people were fully involved in ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions. However, people’s consent and agreement to their care and support was not always accurately reflected in their plans of care.

People, relatives and health care professionals were positive about the skills, experience and abilities of permenant care staff who received the training, supervision and support they needed to perform their roles effectively.

People were supported to eat a healthy balanced diet that met their individual needs and dietary requirements. Menu choices and alternatives were available at mealtimes and people were given appropriate levels of support by staff who were familiar with their personal preferences.

Staff met people’s day-to-

The inspection took place on 18June 2015 and was unannounced. At our last inspection on 04 July 2013, the service was found to be meeting the required standards. Fosse House is a purpose built residential care home. It provides accommodation and personal care for up to 81 older people, some of whom live with dementia. The home is comprised of residential, dementia care and enablement units spread over two floors where staff look after people with varying needs and levels of dependency. At the time of our inspection there were 76 people living at the home.

There is a manager in post who has registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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 and associated Regulations about how the service is run.

The CQC is required to monitor the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. At the time of the inspection we found that some people had aspects of their freedoms restricted. It was unclear in some cases as to whether appropriate applications had been made in full compliance with the DoLS and relevant requirements of the MCA 2005.

Staff obtained people’s consent before providing the day to day care they required. However, where ‘do not attempt cardio pulmonary resuscitation’ (DNACPR) decisions were in place, we found that some had not been made with the proper consent of the people concerned or in line with the MCA 2005.

People told us they felt safe at the home. Staff had received training in how to safeguard people against the risks of abuse. However, not all staff knew how to report concerns externally.

We found that the effectiveness of staff deployment lacked consistency across different units at the home. In some units we saw there were sufficient numbers of staff to meet people’s needs promptly in a calm and patient way. However, in ‘Swallow’ unit on the first floor we found there were often insufficient staff to cope with the demands placed upon them.

Safe and effective recruitment practices were followed to check that staff were of good character, physically and mentally fit for the role and able to meet people’s needs. We saw that plans and guidance had been put in place to help staff deal with unforeseen events and emergencies.

People were positive about the skills, experience and abilities of the staff who supported them. We found that staff had received training and refresher updates relevant to their roles. Staff had regular supervisions to discuss and review their performance and professional development.

We found that people had not always been supported to take their medicines safely or as prescribed. People’s health needs were not met in a safe and effective way in all cases. The environment and equipment used, including mobility aids and safety equipment, were well maintained and kept people safe.

People expressed mixed views about the standard and choice of food provided at the home. We saw that the meals served were hot and that people were regularly offered a choice of drinks. However, although care staff were familiar with people’s dietary requirements, we found that the information was not always shared with the chef in an effective way.

People had access to health care professionals when necessary. However, we found that their health needs had not always been met in a safe and effective way.

Most people told us they were looked after in a kind and compassionate staff who knew them well. However, we found some examples of where support was provided in a way that did not respect or promote people’s dignity. We also found that the quality of care provided often lacked consistency across different units and floors at the home. In some areas we saw that staff provided support in a patient, calm and reassuring way that best suited people’s individual needs. In other areas for example in the ‘Swallow’ unit on the first floor, staff appeared rushed and did not interact with people in a positive or caring way.

People had access to information and guidance about local advocacy services. Information contained in records about people’s medical histories was held securely and confidentiality sufficiently maintained. Although not always obvious in the guidance given to staff, people and their relatives told us they were involved in the planning, delivery and reviews of the care provided.

People told us they received personalised care that met their needs and took account of their preferences. We found that most staff had taken time to get to know the people they supported and were knowledgeable about their likes, dislikes and personal circumstances. However, we found that the guidance and information provided about people’s backgrounds and life histories was both incomplete and inconsistent in many cases.

People expressed mixed views about the opportunities available to pursue their social interests or take part in meaningful activities relevant to their individual needs. We saw that where complaints had been made they were recorded and investigated properly. People and their relatives told us that staff listened to them and responded to any concerns they had in a positive way.

People were positive about the management and leadership arrangements at the home. However, we found that the methods used to reduce risks, monitor the quality of services and drive improvement were not as effective as they could have been in all areas.

At this inspection we found the service to be in breach of Regulations 11, 12, 17 and 18 of 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.

During our inspection, we spoke with a number of people who use the service. One person said, "Everything is fine. The staff are excellent and so is the food. I have no complaints." Another person said, "I am well cared for. The staff are nice. There are enough activities provided for us. I do join in sometimes. I have no concerns." One relative said, “The staff are very good and very caring. They keep us well informed. I observed two staff responding immediately when the call bell rang. I was very impressed by their response.”

We found that the home was meeting the standards we had inspected. People's needs had been assessed and were being met appropriately. There was a system for the administration and management of medicines. There were sufficient numbers of staff on duty to meet the needs of people and there were systems in place to assess and monitor the quality of service.

During our visit on 16 July 2012, the people we spoke with said that they were happy with the care and support they received. They felt that their needs were being met by a trained, qualified and competent staff team. They were complimentary of the food and the quality of service they received.

People with whom we spoke said that they had choice and dignity in their day to day

lives and said 'You can please yourself when you get up and go to bed' and 'The staff

are good with your dignity and they are respectful.'

A relative told us that the care as it is now is absolutely fine and that staff have been very attentive to their relative. They said "There are some really good people working here."

A visiting health professional with whom we spoke praised the staff saying they were "very helpful and friendly, informative, they had a good rapport and relationship and that it "works like clockwork."

Relatives told us they were confident that people were safe living in Fosse House. One person said "I believe my relatives are absolutely safe here."

Relatives had very positive views about the staff team. They told us: "They are absolutely brilliant here, you can just tell it comes from the heart, it's very reassuring." and "There is always someone here to talk to if we need to, they drop everything to talk to us" and "The manager has been fantastic since she's been here."

Relatives with whom we spoke confirmed that they received annual assurance questionnaires for them to complete, they were confident that any identified shortfalls were addressed immediately. One person said "we have certainly got no complaints."