This inspection was carried out on 8 May 2018 and was unannounced. At the last inspection on 5 April 2017, the provider was found to be meeting the standards we inspected. However there were some areas that required improvement. This was in relation to protocols for medicines prescribed on an as needed basis and care plans lacked sufficient detail to ensure people's individual needs and preferences were met. At this inspection we found that the previous areas that required improvement had mostly been addressed. However, we found that there were areas that were in breach of regulations. This was in relation to ensuring people's safety, staffing and governance systems to ensure standards were met Therefore this meant that this was the third consecutive inspection where the overall rating was requires improvement.

Gosmore Nursing and Care Centre 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.

Gosmore Nursing and Care Centre provides accommodation and nursing care for up to 70 older people some of whom may live with dementia. At the time of the inspection there were 40 people living there.

The service had a manager who had applied to be 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.

People were supported by staff who knew how to recognise risks to their safety. However not all staff knew how to report concerns externally. Risks were not consistently and robustly assessed and managed. People’s medicines were administered in accordance with the prescriber’s instructions. However, there were some areas that needed to be monitored. People and staff told us that there were not always sufficient staff available to meet people’s needs. However we found that staff were recruited safely. Staff training was delivered by ELearning with some face to face training and supervisions had commenced.

The design of the building made it challenging at times to meet people’s needs due to staff being spread across the home and equipment breaking down. There was a variety of food that people enjoyed. However further development was needed for the mealtime experience.

People were supported in accordance with the principles of the Mental Capacity Act 2005 and had access to health and social care professionals when needed. Staff were kind and attentive. However people were not always involved in the planning of their care and confidentiality along with privacy was not consistently promoted.

People received care that met their needs but this was not always person centred and needed further development. Most people’s care plans provided staff with guidance to enable them to support people appropriately. There were plans in place to ensure people were supported in accordance with their preference when they approached the end of their life.

There were systems in place to monitor the quality of the service and resolve any issues identified. However, these had not been robust as they had not identified all of the issues found during the inspection. The provider had not ensured that they were working effectively with other agencies to help improve the service provided. Due to a change of management structure they did not have access to the local authority’s recent action plan or the Provider Information Return (PIR) which had been submitted to the Commission.

People were not always sure who the manager was but staff told us that they were regularly out of the office checking on staff and speaking with people. People, their relatives and staff felt t

This inspection took place on 05 April 2017and was unannounced. When we carried out the last comprehensive inspection in October and November 2016 we found the service was in breach of a number of regulations under the Health and Social Care Act 2008.. As a result the service was rated ‘inadequate’ and placed into special measures. At this inspection we found that improvements had been made in most areas, although some of these improvements still required time to be embedded in the culture of the service. We found some work to make further improvements in other areas was still required.

The service is a nursing home and provides accommodation and personal or nursing care for up to 60 people with a range of needs including those associated with dementia and with life limiting health conditions. At the time of our inspection there were 39 people living at the home. The service consists of two units each supporting both people with nursing needs and those with residential needs. Since the last inspection the provider had started work to move towards having one unit dedicated to people with nursing needs only.

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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home. These were reviewed regularly. Accidents and incidents were recorded and there were processes in place to analyse the causes of these to reduce the likelihood of reoccurrence. People received their routine medicines as they had been prescribed although protocols related to the administration of ‘as required’ (PRN) medicine were not sufficiently detailed. There were robust procedures in place for the safe storage and stock control of medicines.

There were enough skilled and qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place, and the provider had taken steps to ensure that staff were suitable to work with the people who lived at the home. Staff received training to ensure that they had the necessary skills to care for the people who lived at the home and were supported by way of supervisions and appraisals. Nurses were supported to maintain and update their skills to maintain their registration.

People’s needs had been assessed when they moved into the home and care plans were developed from this process. People and their families had been involved in the development of these plans although some we looked at lacked sufficient detail to ensure staff supported people in the way they wished. People’s consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

A range of activities were provided and people we spoke with reported that they had enough to do.. People were supported to have enough to eat and drink and they received support to ensure their health needs were met.

The provider had systems in place to monitor the quality of the service which identified areas for improvement and suggested remedial actions to be taken. Staff were able to contribute to the development of the service through team meetings and understood the visions and values of the service. People and their relatives had opportunities to share their views and make suggestions about how the service could be improved. Complaints about the service were managed appropriately and in line with the provider’s policy.

This inspection took place on 27 October 2016 and the 21 November and was unannounced on both days.

The service was registered with the Care Quality Commission to provide regulated activities in June 2016. However, the provider is part of the same corporate brand as the previous provider and the management within the service remained the same when it was transferred to the new provider. When the service was last inspected in August 2015 we gave it a rating of ‘Requires Improvement’ overall. We found that, although there were enough staff on duty on the day of our inspection in August 2015, this was not always the case. Also, the way in which staff were deployed and the layout of the building meant that people’s needs were not always met. During this inspection we found that this continued to be the case. Although the number of staff on duty had been calculated using the dependency levels of the people that used the service, it had not sufficiently compensated for the difficulties caused by the layout of the building. There were no members of staff visible in some corridors for lengthy periods during the inspection. People and their relatives reported that people continued to have to wait for an unacceptably long time before their needs were met. The number of domestic staff employed was insufficient to ensure that the home was clean and free of bad odours at all times. The home was very hot and this accentuated the bad odours in corridors and people’s rooms. Floor coverings, furniture and equipment were stained and dirty. Some bed rails were damaged. Wheelchairs and mattresses were embedded with food debris and dust.

When we inspected the service in August 2015 we had also identified that improvements were required in respect of supporting people to eat their meals and the assessments of people’s capacity to make and understand decisions in accordance with the Mental Capacity Act 2005. Improvements were also required in respect of care planning for specific medical conditions, activities, using people’s feedback to drive improvements to the service and quality assurance. We found that although some improvements had been made in all these areas further improvement was still required in other areas.

The service provides accommodation for people who need nursing or personal care for up to 60 people. At the time of this inspection there were 54 people living at the home. Care was provided to people in two units. One unit was spread over two floors, whilst the second was housed over three floors. There were separate communal areas for both units on the ground floor, although these were adjacent and connected to each other.

There was a registered manager in place. 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. They were supported by a deputy manager and regular visits from the provider’s regional manager.

People told us that they felt safe at the home. However, some people did not have call bells that they could use to summons assistance if they needed it and we could not be certain that management plans to reduce the risk of harm to people were followed. Whilst systems for the ordering and storing of people’s medicines were robust, people did not always get their medicines as they had been prescribed. Some people received medicines that were to be given before food after they had eaten their breakfast. Other people who had been prescribed creams to be applied to their skin did not have this done as often as had been recommended.

There was a robust recruitment process in place which enabled the provider to be confident that staff were suitable to work at the home. However, some staff had poor language skills and we were concerned about