This inspection was completed on 10 January 2019, by one inspector. The inspection was unannounced, which meant the provider did not have any advanced knowledge of the date of the visit.

Fourways Residential 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. However, the home does not provide nursing care support.

Fourways Residential Home can accommodate a maximum of 20 people. This is a home based across two floors, with considerable alterations having been made to the building to accommodate some of the bedrooms.

The service had 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 previously inspected in 2016, and was rated Good in all domains. At this inspection we found that the service had not ensured compliance with all regulations, and was therefore now rated Requires Improvement.

People were not always kept safe. Medicines were not always managed safely. Whilst we found that medicines were stored securely in a locked trolley, when these were administered, the registered manager did not ensure staff followed safe practice and guidelines.

Adequate risk assessments and comprehensive documentation were in place to ensure people were offered responsive, safe care and treatment. Care plans contained sufficient information. However, this was not always followed. By not adhering to the care plan, people were placed at risk.

People were not being kept safe due to a failure in appropriate monitoring and recording of the environmental risks and what these potentially pose to people using the service.

The service did have robust recruitment processes in place to ensure staff employed were safe to work with people. However, there were significant gaps in training that meant that staff did not have the necessary skills and competency to carry out their role effectively.

Effective systems were not in place to audit the service. Such systems would monitor the care provided in relation to the care plans, therefore highlighting any errors as and when these were occurring. This was specifically important given the number of discrepancies noted between practice and care documents.

People's care was delivered in a dignified way. Privacy was protected, although bedroom doors were noted as having been left open for most of the day and night. It was unclear if all people residing at the service were happy for this to continue.

The management completed audits inconsistently. This meant that they did not have a comprehensive overview of the service. Whilst a management structure existed, this was not effective in ensuring governance of the provision. Information was not always analysed or passed to the correct people, leading to errors in care delivery and poor management. The service, although did not specialise in delivering care to people living with dementia, had a number of people residing at the service with the onset of this condition. The service did not environmentally meet the needs of the people. In addition the provider failed to ensure that a strong management structure was in place and working effectively to monitor the service.

During the inspection we identified several breaches 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 end of this report.

This inspection took place on 21 and 26 April 2016 with follow up telephone interviews on 3 May 2016, and was unannounced.

Fourways Residential Home is a care home that offers accommodation for people who require personal care. The service is registered for up to 20 people, with bedrooms located across the ground and first floor. People who live at the service require assistance related to changing health needs due to increase in age.

The home is required to have a registered manager. The new registered manager was appointed in October 2015. 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.

Good caring practice was observed during the two days of the inspection. People and their families reported they were happy with the support and care provided by the staff. People, and where appropriate, their relatives, were involved in the development and reviewing of care plans. These were documented appropriately, detailing individual preferences well and reflected the person’s needs. Risk assessments specific to the person were contained in files, with guidance on how to manage these risks.

Responsive practice was observed during the inspection. The service responded to the needs of people, offering them both verbal and emotional support. This helped to lower anxiety. People were supported by a team of staff who were competency checked prior to being given responsibility for care. Medicines were kept and managed securely. Comprehensive records were kept of guidelines for as required medicines. Audits were completed regularly and showed no medicine errors. Observations during the inspection process, illustrated that staff correctly followed procedures when administering medicines, therefore kept people safe.

Staff knew how to keep people safe. They were able to describe how to report concerns promptly and confidentially. They were familiar with the internal and local authority procedures that were clearly outlined in training. Comprehensive recruitment processes were in place to ensure suitable staff were employed to safeguard people against the risk of abuse. Sufficient numbers of trained and experienced staff were provided by the service to ensure people’s needs were met. A training programme was in place, which focused on providing the company’s mandatory training as a minimum standard, with additional supporting training offered in line with best practice, meeting the Skills for Care guidelines.

Staff had training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). They understood the importance of informed choice being situation and time specific. Where applicable DoLS applications had been made to the appropriate authority.. Records included evidence of best interest meetings taking place, and staff were able to talk through the decisions that had been made in relation to these.

The quality of the service was monitored by the registered manager and deputy manager. Feedback was obtained from people, visitors, families and stakeholders and used to improve and make relevant changes to the service. Comprehensive audits were completed that produced reflective action plans that identified timescales for the registered manager to make improvements. Evidence illustrated action plans were addressed in a timely way.

The service offered people activities. These were predominantly group focused. We recommended that activities be developed specifically to reflect people’s individual needs and choice.

The home was clean and tidy, although the carpet looked worn and the furnishings had aged. The premises did not lend themselves to provide care to people with dementia. As structural changes to the premises could not easily be mad

An adult social care inspector carried out this inspection. The focus of the inspection was to follow up on the key question; is the service safe?

As part of this inspection we spoke with the deputy manager and reviewed records relating to the recruitment of staff. Below is a summary of what we found. The summary describes what we were told, what we observed and the records we looked at.

Is the service safe?

There were effective recruitment and selection processes in place.

Appropriate checks were undertaken before staff began work. We reviewed the recruitment files of eight members of staff and the records we looked at were accurate and fit for purpose.

One inspector carried out this inspection. They gathered evidence against the outcomes we inspected to help answer our five key questions;

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. The summary describes what we observed, the records we looked at and what staff told us.

Is the service safe?

Care and treatment was planned and delivered in a way that was intended to ensure people’s safety and welfare.

Staff personnel records did not contain all the information required by the Health and Social Care Act. This meant the provider could not demonstrate that the staff employed to work at the home were suitable. A compliance action has been set in relation to this and the provider must tell us how they plan to improve.

People’s personal records including medical records, staff records and other records relevant to the management of the service were accurate and fit for purpose.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). A recent Supreme Court judgement had widened and clarified the definition of deprivation of liberty. The manager was not aware of this judgement relating to ‘deprivation of liberty’ but undertook to make contact with the local authority DoLS team, regarding the implications, when notified of this during the inspection.

Procedures for dealing with emergencies were in place and staff were able to describe the action they would take to ensure the safety of the people who use the service.

Is the service effective?

Care plans provided staff with the detailed information needed to enable them to provide care that met people’s needs.

Staff were consistent in how they said they would support particular people’s needs.

The service liaised effectively with other professionals such as GP’s, District Nurses and other health care professionals.

Is the service caring?

Staff showed a positive and understanding approach towards the care needs of people who use the service.

People were supported by kind and caring staff who spoke politely to them. We saw that care workers showed patience and gave encouragement when supporting people.

Is the service responsive?

Care plans and risk assessments were reviewed regularly. If any changes to people’s care needs were identified, they were recorded and acted upon.

Records confirmed people’s preferences and interests. People’s diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service well-led?

The provider had appropriate systems in place to effectively assess and monitor the quality of care they provided to people who use the service.

Incidents and accidents were monitored and analysed appropriately.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good quality service at all times.

People told us the staff were kind and caring but they were also very busy. One person told us there was not enough for them to do at Fourways and another told us they would like to go out more. One relative said "I have no complaints but the furniture could do with an upgrade".

We looked in the records of five people and found they did not contain appropriate risk assessments and plans of care that provided staff with the information they needed to provide safe and appropriate care and support. We spoke with the new manager who told us they had identified issues with the records that needed to be resolved.

The provider did not have a system to regularly assess and monitor the quality of care at Fourways. This meant it was not always possible for the provider to identify incidents that may have resulted in unsafe or inappropriate care.

The people who use this service prefer to be referred to as residents. This preference is respected within this report.

Residents we spoke with felt that staff were available when they needed them and that the staff all had the skills they needed when providing their care and treatment. Residents were complimentary about the staff, comments received included: 'the staff are always happy and smiling' and 'they are always up to date, they are very good.'

Since our last inspection at Fourways Residential Home the registered manager has retired. At the time of this inspection the organisation's new Compliance/Operations Manager was acting as manager at the home until the newly appointed manager took up her position.

The people who use this service prefer to be referred to as residents. This preference is respected within this report.

Residents we spoke with told us they had helped to plan the care they received and felt they were involved in making decisions about their care. They felt the staff respected their privacy and dignity and that they helped them to remain as independent as possible.

Residents told us they felt safe living at the home and felt the staff had the skills they needed when providing their care and treatment.

Residents told us they felt their views were actively sought by the home and that their opinions were listened to and taken into account by the management and staff.

This visit was carried out following information received from the local Environmental Health Officer relating to food hygiene standards.

On this occasion we did not speak with people living at the home about the reasons for our visit, so cannot report what they said.