This unannounced inspection took place on 22 May 2018.

Gorselands Residential Home provides accommodation, support and care for up to 21 older people, some of whom are living with dementia. People in care homes receive accommodation and 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. At the time of our inspection 18 people were using the service.

There was no registered manager in place but a new manager had been appointed who had previously been the registered manager and they had applied to be registered again. 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.

At our previous comprehensive inspection which was carried out on 22 and 23 February 2017 we rated the service as Requires Improvement. During that inspection we identified breaches of regulation relating to the unsafe management of medicines and poor monitoring of risk. The service was also in breach of the same regulations at the previous inspection in July 2016, alongside breaches relating to person centred care, consent and staffing.

Following our February 2017 inspection we placed additional conditions on the provider’s registration. We required the provider to send us monthly audits relating to medicines and the analysis of accidents and incidents to ensure a better overall management of risk. The provider has not always complied with this requirement and the quality of the information supplied has not always been acceptable. We had not received any monthly update in the four months leading up to this inspection.

During our current inspection we found some improvements with regard to the management of the service under the new manager but we also identified some significant concerns about people’s safety. We have identified continued breaches of regulation relating to the management of medicines and the management of risk. In addition we found that staffing levels constituted a breach of regulation.

We could not be assured that medicines were always managed safely as stocktaking measures were not effective. We also identified some recording errors relating to the administration of controlled drugs which audits had not picked up.

Risks were not always well managed. Hot water posed a potential risk as did the lack of effective security for people who were not safe to go out into the community without support. Staffing levels meant sometimes people were left without staff support which increased any potential risks.

Staff understood their responsibilities with regard to keeping people safe from the risk of abuse but some safeguarding matters had not been promptly notified to CQC.

Infection control procedures were in place and staff demonstrated an acceptable knowledge of how to reduce the risk and spread of infection.

Staff were well trained and supported in their roles. They were positive about the support of the new manager and supported the initiatives she had put in place to try and drive improvement at the service. Further relevant training, such as that for end of life care, was planned to increase staff skills and knowledge.

People had good and prompt access to healthcare and staff worked well with other healthcare professionals to meet people’s healthcare needs. Some improvements were needed with regard to the oversight of people’s eating and drinking to ensure people always had their needs met.

The service needed to improve their practice with regard to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people do not

This inspection took place on 22 and 23 February 2017 and was unannounced. Gorselands Residential Home is a care home providing personal care for up to 21 people, some of whom live with dementia. On the day of our visit 18 people were living at the home.

The last registered manager left the position in November 2014, although their registration with us was not cancelled until February 2016. 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. There was a manager in post during this visit who was in the process of applying for registration with us.

At the last inspection on 12 July 2016, we asked the provider to take action to make improvements to assessing risks to people, staffing levels, medicine management, mental capacity assessments, care planning and activities, and monitoring the quality of the service. Some of this action, such as completing individual risk assessments, mental capacity assessments, staffing levels, and the availability of activities and social stimulation for people had been improved. Other areas, such as care planning records had been reviewed and improvements were on-going. There had not been enough improvement in two areas.

People did not always receive their medicines when they needed them, and medicine administration records did not always show why medicines had not been given.

The quality of the service was not effectively monitored for the risks to people, to ensure that these were reduced as much as possible and to improve the quality of the care provided.

You can see what action we told the provider to take at the back of the full version of the report.

Staff were aware of safeguarding people from the risk of abuse and they knew how to report concerns to the relevant agencies. They assessed individual risks to people and took action to reduce or remove them.

There were not always enough servicing and maintenance checks to fire equipment and systems in the home to ensure people’s safety.

People felt safe living at the home and staff supported them in a way that they preferred. There were enough staff available to meet people’s needs and the manager took action to obtain additional staff when there were sudden shortages. Recruitment checks for new staff members had been made before new staff members started work to make sure they were safe to work within care.

Staff members had received training, to provide them with the skills and knowledge to carry out their roles, although this training was not always refreshed or up to date. Staff received adequate support from the manager and the provider’s representative, which they found helpful.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The manager had acted on the requirements of the safeguards to ensure that people were protected. Where someone lacked capacity to make their own decisions, the staff were making these for them in their best interests.

People enjoyed their meals and were able to choose what they ate and drank. They received enough food and drink to meet their needs. Staff members contacted health professionals to make sure people received advice and treatment quickly if needed.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated. They responded to people’s needs well and support was always available. Care plans contained enough information to support individual people with their needs. People were happy living at the home and staff supported them to be as independent as possible.

A complaints procedure was available and people knew how to and who to

The inspection took place on 12 July 2016 and was unannounced.

The home is registered to provide accommodation with personal care for up to 21 older people. On the day of our visit there were 19 people living at the home.

The nominated individual was currently overseeing the running of the home. A nominated individual is a person named by the organisation as responsible for supervising the management of the running of the service. This person is referred to as the ‘provider’ hereafter.

At the time of our inspection there was no 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 2008 and associated Regulations about how the service is run. There has not been a registered manager in post for three years. There have been care managers in post, but these have not registered with us.

People felt safe at the home and staff were knowledgeable about safeguarding adults and the different types of abuse to look out for. They knew what action to take if concerned about possible abuse.

The safety of people living at the home had been compromised on a number of occasions in terms of day to day care. There were not enough staff on duty to always meet people’s needs or preferences. Care was delivered in a task orientated way rather than based on the person’s individual need.

Some care records and risk assessments were not up to date and did not reflect changes in need for people living at the home. Risk had not always been assessed and appropriate steps were not always put in place to keep the person safe. Medicines were not always managed safely and staff did not have accurate notes to confirm if people had received their medicines.

The Care Quality Commission monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The service was not acting in accordance with the principles of the MCA. People’s capacity to make decisions had not always been assessed when there was a change to their mental health. Best interests decisions were not being made.

Staff sought consent from people regarding their immediate care needs. Staff had received training and said that most of the time they felt supported.

People living at the home received enough food and drink, and there was choice available at meal times. People health care needs were assessed, monitored and recorded, and referrals for assessment and treatment were made. Where people had appointments within healthcare services, staff supported them to attend these.

People’s rooms were decorated with their personal belongings so that they were comfortable and the area was made into their own space as much as possible. People’s feelings were not always taken into consideration by staff, and sometimes people’s dignity was affected because of this.

There were mixed feelings from people living at the home about raising concerns. Some people felt happy to do so whilst others were unsure if they would be listened too.

The provider did not have any effective systems in place to monitor the quality of the service or the running of the home. Health and safety audits were also out-of-date and evacuation plans for people were not easily accessible in the event of an emergency.

You can see what action we told the provider to take at the back of the full version of the report.

During our discussions with people living at Gorselands, we were told about their choices and how they felt informed about their care. People told us they were given full information about the support they would be given which meant people were supported to make appropriate decisions. We saw that people had signed to confirm their agreement on their care plans.

We looked at care plans that clearly explained how a person preferred to be supported. For example, records showed where a person had been asked what time and how often they wished to undertake certain activities, showing people were fully consulted at every stage.

At our inspection all areas of the service were clean and tidy. We found that the routines and systems in place supported the well being of people using the service and minimised the risk of infection.

Staff received training and supervision on a regular basis and staff told us they felt fully supported by the manager at all times. This ensured that staff had the relevant training to meet the needs of people and that the manager was aware of any areas that needed strengthening.

We saw there was information on display for people to use if they had any complaints. Staff told us that people usually spoke directly with the manager if they had any problems and this was also confirmed when we spoke with people living in the home.

On our arrival at the home, people were very keen to speak with us and tell us how comfortable they were living at Gorselands. Staff explained to people living in the home about our inspection and people wanted to discuss their experiences with us.

People told us that staff always provided support as people had chosen and that Gorselands was a ‘home from home’. They said they had very good food and that they had more than enough to eat at all their meals. They also confirmed that they were given choices and encouraged to voice their opinions at every opportunity.