This inspection took place on 16 and 17 January 2019 and was unannounced. At our last inspection in September 2018 the service was rated as ‘inadequate’ and the following concerns were raised:

The provider had failed to ensure that the service was safe as they had not taken prompt action to comply with the fire regulations. Management of medicines was not robust, and risk assessments and training was not in place to guide staff on how to safely hold people during personal care interventions. This resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

The provider had failed to ensure that all people were receiving care that was responsive to their

individual needs. This resulted in a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

There were insufficient systems in place to monitor and improve the quality of the service.

This resulted in a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) 2014. At this inspection we found improvements had been made.

Following the last inspection, we asked the provider to complete an action plan to show what actions they would take and by when, in order to improve the ratings of the key questions of Safe and Well Led, from inadequate to at least good. We also asked them to provide us with monthly reports outlining the actions taken and progress made against the issues raised. At this inspection, we found the required improvements had been made and systems were in place to continue to monitor the care and support provided at the service.

Gingercroft 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. Gingercroft accommodates up to 21 people in one adapted building. At the time of the inspection, 17 people were living at the service.

There was a registered manager in post who supported us throughout the inspection. 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.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and they are no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

Improvements had been made since our last inspection and all fire doors had been fitted to ensure the service met the fire regulations. The provider now visited the service on a regular basis and completed audits to ensure they had oversight of the service provided. The registered manager received support in her role and also completed audits to maintain her oversight of the service. Records had been updated and staff had received the required training to meet people’s needs. However, further time was needed to ensure these improvements were embedded and sustained to continue to drive improvement in the home.

Staff were aware of the risks to people and how to manage those risks. Staff knew how to escalate any concerns they had about people in order to safeguard them from harm. People told us there was enough staff to meet their needs, and that they received their medicines as prescribed. People were protected from the spread of infection and where incidents and accidents took place,

This unannounced inspection took place on 6 and 11 September 2018. This was the provider's first inspection since registration.

Gingercroft 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. The home is registered for up to 21 people. At the time of the inspection 19 people were using the service.

There was a registered manager in post who supported us throughout the inspection. 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.

At the inspection on 6 September 2018 we found concerns about the safety of the service and the governance systems in place to ensure continuous improvement. We wrote to the provider asking them to immediate action to improve. We returned to the service on 11 September 2018 and found that some action had been taken, however further improvements were required. We found three breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The overall rating for this service is Inadequate which means it will be in special measures.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration. For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

There had been a failure in the leadership and governance of the service. There were no systems to monitor or improve the quality of care and no strategic vision or provider oversight.

The service was not safe as the provider had not taken prompt action to comply with the fire regulations. Risks associated with fire safety had not been minimised. The systems the provider had in place to ensure the quality of the service was maintained were ineffective.

Risks associated to supporting people with behaviour that challenged had not been assessed. People were not being supported safely when showing signs of anxiety and aggression. People's medicines were not always stored and administered safely and substances hazardous to health were not managed safely.

The principles of the Mental Capacity Act 2005 had not been followed to ensure that people's capacity to consent to their care had been assessed. Staff felt supported however they had not