This inspection took place on 13 February 2017. The inspection was unannounced. The last comprehensive inspection of the service was in June 2016. At that inspection we found the service was in breach of six regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Warning notices were issued with respect to the breaches of Regulations 12 (Safe care and treatment) and 15 (Premises and equipment). Requirement notices were issued for Regulations 9 (Person centred care), 10 (Dignity and respect), 17 (Good governance) and 18 (Staffing).

The registered manager and provider sent us action plans in August 2016 outlining the improvements they were going to make in order to meet the requirements of the regulations.

We carried out a focused inspection on 11 October 2016 to ensure the requirements of the warning notice for Regulation 12 (Safe care and treatment) had been met. We found the registered manager and provider had taken action to address all of the areas identified within the warning notice.

The inspection of 13 February 2017 was a comprehensive inspection to follow up and ensure the requirements of the warning notice for Regulation 15 (Premises and equipment) and the previously identified breaches of regulations had been met and to make a judgement about the overall compliance of the service.

We found the service had made sufficient improvements that it was now compliant with the regulations. Improvements seen at the focussed inspection in October 2016 had been sustained.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. The home is required to have 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. At the time of the inspection there was a registered manager at the service and they assisted throughout the inspection.

Risks to people’s safety were assessed and management plans now provided more detailed guidance on how to minimise risks to people’s safety. Plans were in place to manage foreseeable emergencies and individual personal evacuation plans had been reviewed and were in place for all people using the service.

People were protected by staff who understood their responsibilities to safeguard people and knew how to report concerns. Staff were recruited safely and there were sufficient staff to provide safe and effective care. Medicines were managed safely.

The service was clean and tidy. People had benefitted from a refurbishment programme including redecoration, replacement furniture and fittings. Carpets had been repaired and cleaned where necessary and further improvements to flooring in the service were being discussed to ensure the most appropriate choice was made.

Staff supported people’s day to day health, nutrition and care needs effectively. People had access to healthcare professionals when required. People were provided with nutritious food tailored to their choice and tastes. When necessary people’s food and fluid intake was carefully monitored.

Staff were supported through training, one to one supervision and appraisal of their work. Regular team meetings and group supervision sessions enhanced the level of support provided to the care team.

Staff sought people’s consent before offering care and understood people’s rights in relation to making decisions. Appropriate authorisations were in place when people’s liberty was restricted. 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.

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At the comprehensive inspection of Haldane House Nursing Home on 8, 10 and 13 June 2016 we identified six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 (HSCA). We issued the provider with two warning notices and four requirements stating they must take action to address these breaches. We shared our concerns with the local authority safeguarding team.

This focused inspection was carried out to assess whether the provider had taken the necessary actions to meet the warning notice we issued in relation to Regulation 12 (HSCA) which relates to safe care and treatment. We will carry out a further inspection to assess the actions taken in relation to the second warning notice and the four requirement notices and to provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notice we issued with regard to Regulation 12 (HSCA) and we have not changed the ratings since the inspection in June 2016. The overall rating for this service is 'Requires Improvement'. You can read the report from our last comprehensive inspection by selecting 'all reports' links for Haldane House on our website at www.cqc.org.uk.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. At the time of our visit there were 24 people living there.

The home is required to have 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. At the time of the inspection there was a registered manager at the service and they assisted with the inspection.

At this inspection we found the provider had taken action to address the issues highlighted in the warning notice. The provider and registered manager had submitted a comprehensive action plan to address the breaches of regulations.

During our last inspection we found that risks assessments had not always been completed. People’s care and support plans did not always contain safe systems of work or detailed information for staff to follow in order to minimise risks. At this inspection risks assessments had been reviewed and updated to contain guidance for staff on how to minimise the risk of harm to people.

At our last inspection we found not all staff had received up to date training in moving and handling people. We could not be sure if training included practical as well as theoretical training. At this inspection the training certificates clearly indicated the practical elements of the training provided as well as the theory. All staff had received appropriate training and the provider had installed a new computerised system to record all training and alert managers when refresher training was required.

Staff were confident in their approach to assisting people to move or transfer and used appropriate techniques to promote people’s safety. The registered manager and senior staff worked alongside staff to promote best practice and provide guidance for care staff.

The inspection took place on 08, 10 and 13 June 2016 and was unannounced. We last inspected the service in June 2014. At that inspection we found the service was compliant with all the essential standards we inspected.

Haldane House is a care home with nursing. It provides accommodation and nursing care for up to 25 people. Some of the people using the service are living with dementia. The home is required to have 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.

At the time of the inspection there was a registered manager at the service. They assisted with the first day of the inspection before going on leave. The deputy manager and general manager assisted with the second and third days of the inspection.

Risks to people’s safety were not always assessed and when they were, the assessments were not always accurate or acted upon. Measures were not always taken to reduce or manage the identified risks to people’s safety and well-being.

Although the service was generally clean and tidy we found scale on sinks and taps as well as damage to furniture, exposing areas which may harbour bacteria.

The provider did not have a comprehensive contingency plan in place to ensure the safe continuation of the service in the event of a foreseeable emergency. Health and safety audits were completed but did not always identify risks to people.

Staff did not always understand their responsibilities to safeguard people. Accidents and incidents were not always reported or investigated.

Staff were recruited safely but there was no system in place to determine how many staff were required to meet people’s need effectively.

Medicines were managed safely and people received them when they needed them. People had access to effective healthcare from a GP and other healthcare professionals when required.

People were provided with nutritious food tailored to their choice and tastes. When necessary people’s food and fluid intake was carefully monitored.

Although staff told us they felt supported we found they did not always receive the training and supervision that they needed to meet people's needs effectively.

Staff sought people’s consent before offering care. However, not all staff understood their responsibilities with regard to the Mental Capacity Act 2005 (MCA). Therefore we could not be assured people’s rights to make decisions were always protected.

People’s privacy and dignity was not always respected. There was lack of opportunity for people to spend time alone or with their visitors. Care was not always focussed on individual people but more on completion of tasks and routines.

People were treated with kindness by friendly and attentive staff. People and their relatives spoke highly of the staff team and praised their hard work.

The provider did not have an effective governance system to monitor the quality of the service. Effective audits were not carried out and the provider had not identified the issues we found at this inspection.

We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have asked the provider to take at the end of this report. CQC is also considering other appropriate regulatory response to resolve some of the concerns we found and will report on any

action taken when it is completed.

An adult social care inspector carried out this inspection accompanied by an observing auditor. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of this inspection we spoke with two people who use the service, two visitors, the registered manager, the deputy manager, two care staff, the chef and the General Practitioner who regularly visited the home. We also reviewed records relating to the management of the home which included, four care plans, daily care records, risk assessments, audits, policies and procedures. We also spoke to the local authority Commissioners.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

Is the service safe?

People were cared for in an environment that was safe. People’s records showed they had access to routine and specialist health services. People regularly saw doctors and when appropriate, other specialist health professionals. Directions from professionals were recorded accurately in the care plan and staff we spoke with knew how to access and follow them.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We spoke with the manager with regard to the Supreme Court ruling which widened and clarified the definition of deprivation of liberty. They were aware of the ruling and had been in contact with the local authority deprivation of liberty safeguards (DoLSs) team. They were waiting for further guidance from this team before making any further applications. We saw one application had been made and Deprivation of Liberty Safeguards were being used appropriately.

Is the service effective?

People all had an individual care plan which set out their care needs. People had access to a range of health care professionals including speech and language therapists, tissue viability nurses and dieticians.

We observed staff supporting people in a friendly, kindly and patient manner. We saw choice being offered and explanations given. People said staff helped and explained things to them. One person said: “staff are very friendly and helpful.”

People were supported to be able to eat and drink sufficient amounts to meet their needs. We observed the tea time activity and spoke with people afterwards. They told us they thought the food was, “very good.” Relatives of people living at the home told us: “the food is good, balanced and plentiful.”

During our visit we saw staff supporting people with activities and we observed people smiling. We observed people who had become distressed being supported appropriately and responded to in a positive manner.

Is the service caring?

People said they were supported by kind and attentive staff. One person said: “staff care.” Our observations confirmed this and we saw people being spoken to politely and with respect. Staff were patient and encouraging when supporting people in everyday tasks and activities. One relative said they were very happy with the care their relative received, calling it: “amazing” and another said it was: “excellent.”

Is the service responsive?

People and staff we spoke with told us they enjoyed the social gatherings organised by the home. We saw an event was organised for the weekend after our visit. We observed staff speaking to people about this event and people were smiling in response. Relatives we spoke with confirmed these events were a highlight for everyone connected to the home.

People’s needs had been assessed before they moved into the home and were reviewed with them and their relatives as appropriate. Records confirmed their preferences, interests, aspirations and needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and they had been supported to maintain relationships with their friends and relatives.

We spoke with two people and two relatives of a people who use the service. They told us they could talk to staff if they were unhappy about something. They all felt confident they would be listened to. One told us: “I’ve only had to raise minor things and they are put right straight away.”

Is the service well-led?

Quality assurance processes were in place. Staff told us they felt they could approach the manager for advice. They knew and understood their responsibilities and the importance of their role. Regular staff meetings were held to ensure staff were up to date. Staff we spoke with confirmed they were able to discuss matters with the manager who held an “open door” policy. People and their relatives said they were consulted about their views and they completed satisfaction questionnaires.