Framland 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.

Framland provides personal care and accommodation for up to 31 older people some of whom have dementia. On the day of our inspection there were 23 people living at the service.

At the last inspection in May 2017, the provider breached Regulation 17, Good Governance. The service was rated as overall ‘Requires Improvement’ with a ‘Requires Improvement’ rating in the Safe, Effective, Caring and Well-led domains. The provider wrote to use to say what they would do to meet legal requirements in relation to the breach.

At this inspection carried out on 7 August 2018, we found the provider had implemented the necessary improvements to support the rating of ‘Good’.

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.

People told us they felt safe living at Framland. Their relatives agreed with what people told us. The registered manager and the staff team knew their responsibilities for keeping people safe from avoidable harm and knew what to do if they were concerned people were being harmed.

People’s care and support needs had been assessed prior to them moving into the service and the risks associated with their care and support had been regularly reviewed and managed. Checks had been carried out on the environment in which peoples care and support was carried out, and on equipment used, to ensure it was safe.

The registered manager made sure lessons were learned when things went wrong to ensure people were provided with a safe place to live.

People were supported with their medicines in a safe way and staff competency in administering medicines had been checked to make sure people were supported effectively.

The registered manager followed the providers recruitment process. Checks had been carried out on new members of staff to make sure they were suitable to work at the service and relevant training had provided them with skills and knowledge to care for people.

People told us they thought there were currently enough staff members on duty to meet their care and support needs. The registered manager assessed people's dependency levels on a monthly basis to make sure appropriate numbers of staff were deployed.

Plans of care had been developed for each person using the service and their likes and dislikes and personal preferences had been explored. The staff team knew the needs of the people they were supporting well.

People were provided with a comfortable place to live and there were places within the home which enabled people to either spend time on their own, or with others. Training in the prevention and control of infection had been completed by the staff team and the necessary protective personal equipment was available and used.

The staff team were kind and considerate and treated people with respect. The staff team always obtained people’s consent before they offered care and support and they supported people in the way they preferred.

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.

The staff team supported people to make decisions about their day to day care and were aware of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). This made sure people's human rights were protected.

People's food and drink requirements had been assessed and a balanced diet was b

We inspected Framland on 23 May 2017. The visit was unannounced. This meant that the staff and the provider did not know that we would be visiting.

Framland is located in Melton Mowbray, Leicestershire. The service provides accommodation for up to 31people who require personal care. There were 27 people using the service at the time of our inspection.

The service 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.

People told us they felt safe living at Framland. The staff team knew their responsibilities for keeping people safe from harm. This included reporting any concerns to a member of the management team.

Assessments had been carried out on the risks associated with people’s care and support. This enabled the registered manager and management team to identify and reduce the risks presented to both the people using the service and the staff team.

People’s thoughts on staffing levels at the service varied. Whilst some people felt there were enough staff members to meet their needs, others did not. This resulted in people having to wait for support from the staff team or it having an impact on the care they preferred.

Appropriate checks had been carried out when new members of staff had started working at the service. This was to make sure that they were suitable and safe to work there. An induction into the service had been provided and on-going training was being delivered.

There were systems in place to audit the medicines held at the service and appropriate records were being kept.

Not all areas within the home were clean, appropriately maintained or hygienic.

People received support from a staff team that had the necessary skills and knowledge. New members of staff had received an induction into the service when they were first employed and training relevant to their role had been provided.

People had been involved in making day to day decisions about their care and support. Where people were unable to make their own decisions, these had been made for them in consultation with people who knew them well and in their best interest. The staff team were working in line with the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards.

People’s nutritional and dietary requirements had been assessed and a balanced diet was being provided. For people who had been assessed to be at risk of not getting the food and drink they needed to keep them well, appropriate records were kept so that this could be monitored.

People were supported to maintain good health. They had access to relevant healthcare services such as doctors, community nurses and opticians and they received on-going healthcare support.

People told us that the staff team were kind and caring. The relatives we spoke with agreed with this. On the whole we observed the staff team treating people in a kind manner though there were some occasions where this could have been improved.

Whilst activities for people using the service were being provided, these were being carried out by the care staff team alongside their other duties. Records did not always show that people were regularly supported to follow their hobbies or interests.

People had plans of care that reflected their care and support needs. These provided the staff team with the information they needed in order to properly support people using the service though these had not always been followed. Staff knew the people they were supporting including their likes and preferences.

A complaints procedure was in place and people we spoke with were aware of who to talk to if they had a concern of any kind.

The staff team felt supported by the registered manager. Th

This inspection took place on 8 March and was unannounced. At our previous inspection 9 October 2014 we found that the service was in breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, which corresponds to regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan telling us about the actions that they were going to take. At this inspection we found that the improvements had been made and the provider was compliant with the regulation.

Framland is located in Melton Mowbray, Leicestershire. The service provides support and accommodation for up to 31 people. This includes older people with age related needs, people living with dementia and younger adults. At the time of our inspection there were 27 people using the service.

There is a registered manager at the service. 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 told us that they felt safe at the service and staff had a good understanding of how to identify and report any concerns.

There were some policies and procedures in place to ensure that people medicines were managed safely however these were not always consistently followed.

Some areas of the service had a strong smell of urine and had not been appropriately cleaned to protect people from associated risks.

Staff had a good understanding of people's needs. Staff were effectively supported to carry out their roles.

Staff sought people's consent before assisting them in any way. Where people lacked the capacity to consent to their care the service acted in accordance with the principles of the Mental Capacity Act 2005.

People were provided with a balanced diet and varied diet. People had access to appropriate healthcare services. Staff identified and reported any concerns relating to people's health to appropriate healthcare professionals.

People told us that staff treated them with dignity and respect. People chose were they spent their time.

People were involved in making day to day decisions about their care and support. Activity sessions were available but they did not reflect people’s individual hobbies and interests.

The service had not always followed their own complaints procedure. They had not always used complaints to further develop the service.

Environmental audits had been carried out but these had failed to identify and address the environmental issues that we found.

People and staff members spoke highly of the registered manager.

This inspection took place 9 October 2014 and was unannounced.

Framland is located in the town of Melton Mowbray Leicestershire. The service provides accommodation for up to 31 older people. On the day of our visit there were 31 people using the service.

There was not 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 and associated Regulations about how the service is run.

People who used the service made positive comments about the care and treatment provided. They praised the staff and spoke positively about the relationships they had formed with staff and with other people who used the service.

People were supported by staff who had received training on how to protect people from abuse. Safeguarding procedures were in place and staff knew what action to take and who to report concerns to.

Risk was assessed but management plans were not always detailed enough or followed. This meant that people were not always properly protected from harm.

The way that the premises were used and how they had been maintained meant that there were areas that were important in relation to infection control which were difficult to clean effectively. These areas were not clean. We have made a recommendation about the prevention and control of infections.

There was an ongoing programme of staff training and development. Staff had a basic awareness of caring for people with dementia. We found that best practice developments were not always implemented.

Staff were aware of the Mental Capacity Act and Deprivation of Liberty Safeguards but had not consistently followed the requirements of this legislation.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. People had access to healthcare professionals as soon as this was required.

Staff were kind and compassionate. However some staff did not always anticipate or meet people’s individual needs. There was not always a member of staff in attendance in the communal areas to keep people safe. Improvements were needed to ensure the staff had the time to meet people’s individual care preferences and attend properly to their safety and wellbeing.

Staff were clear about their roles in ensuring that people were given choice and had their independence promoted. Activities such as bingo, quizzes and other games were provided. Some people had very limited opportunities to take part in activities that were meaningful to them.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we spoke with four people who used the service and five members of staff. Below is a summary of what we found. The summary describes what people using the service and the staff told us and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve. Staff knew about risk management plans and told us about how they had followed them.

The provider ensured that staff rotas where planned so that people's care needs were taken into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met. People had their needs assessed before they began using the service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Relevant policies and procedures were in place and the registered manager understood when an application should be made, and how to submit one.

Is the service effective?

People's health and care needs were assessed before they moved in. Each person had a care plan in place and this was evaluated at least monthly.

Staff received the training and support they required to do their job and to keep people safe.

Is the service caring?

We spoke with four people who used the service. We asked them for their opinion about the staff that supported them. Feedback from people was positive, for example, “the staff can’t do enough for you”. We observed staff interacting with people who used the service. We saw that staff were kind, helpful and respectful.

When speaking with staff it was clear that they genuinely cared for the people they supported. They were positive about their role and said they liked working at Framland.

Is the service responsive?

People knew how to make a complaint if they were unhappy. People told us they could speak with the staff at any time.

We saw that staff referred people to appropriate healthcare professionals such as GP’s and community nurses as soon as this was required.

Is the service well led?

The provider had a quality assurance system, and records showed that identified problems and opportunities to change things for the better were addressed promptly. As a result the quality of the service was continuously improving.

We spoke with four people who used the service and to one relative. They told us they received the care and support they required and liked the staff. One person said "they are very good". Another person said " If I have a problem, they will sort it". A relative said "I get a lot of support from the staff. If there is anything wrong they will call me".

We found that staff were not always following the correct policies and procedures for the prevention and control of infection.

Equipment was provided in sufficient quantities to meet the needs of people who used the service. Some furniture required refurbishment or replacement.

The majority of staff had received the training they required to do their jobs. Staff we spoke with told us they felt supported by their managers.

Processes were in place to assess and monitor the quality of the service provided. This included seeking the views of people who used the service. The provider had not quality assured all aspects of the service.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

We spoke with two people who used the service and to two relatives. They told us they were satisfied with the care and support they received. They told us they got on well with the staff. A relative told us how staff ensured their relative was occupied and engaged. Another relative told us how well their mother had settled at the service and said "the seniors are brilliant".

The provider had increased staffing numbers since our last visit. We found that the number of accidents and incidents had reduced. People who used the service had more opportunities for social and recreational activities.

We carried out this inspection to follow up non compliance identified during our inspection of 16 July 2012. We spoke with four people who used the service and two relatives. People told us they liked living at Framland. One person told us that some of the staff were very good and they could talk to them. We found that the provider had made significant improvements and had achieved compliance in outcome four. Care and assessment records were reflective of people's individual needs.

We found that staff had received training. However we were concerned that staffing levels were not sufficient to meet people's needs or to keep them safe. We were also concerned that the provider did not have effective systems in place for assessing and monitoring the quality of service provision.

People told us they were satisfied with the service they received and liked the staff who supported them One person said 'the food is decent and there is always a choice'.

We spoke with six people who used the service. They told us they liked living at Framland and liked the staff. Two people felt that staff got them up too early in the morning. Some people felt there were not always enough staff and this meant that at times they had to wait for staff to attend to them.

There were very limited opportunities to participate in social and recreational activities. Many people went to bed very early and got up very early in the morning. In the majority of cases it was the person's choice to do this. However, we were concerned that this may be a consequence of people not being engaged in meaningful activity and occupation.

Care plans were not always reflective of people's current needs. Care records did not always sufficiently instruct staff about how to meet people's needs. People who used the service told us they felt safe. Staff did not always follow the correct procedures about safeguarding people from abuse.

Since our last visit, the provider had taken action to address shorfalls in the control and prevention of infection. We found that some areas of the home were not as clean or as well maintained as they should be.

We saw that the provider had made improvements to the audit of service provision. Fire safety checks were carried out within the required frequency.