The inspection took place on 15 November 2017 and was unannounced. Haunton Hall is a care home that provides accommodation with personal and nursing care and is registered to accommodate 90 people. Some areas of the home are unused and awaiting refurbishment; at the time of this inspection accommodation was available for up to 47 people and 46 people were using the service. Haunton Hall accommodates people in one building across four separate units, each of which has separate adapted facilities. One of the units specialises in providing care to people living with dementia; two units provide nursing care and there is residential accommodation. The home is in a rural location and there are extensive grounds and garden areas. There is no public transport to the village of Haunton.

The service had 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 2008 and associated Regulations about how the service is run.

When we completed our previous inspection on 4 January 2017 we found concerns relating to how people received medicines that were on an ‘as required’ basis. This was because there was no information available to ensure all staff knew when these were needed. Prompt action was not always taken to ensure medicines were administered in a form that people could take. Capacity assessments had not always been completed where needed and it had not always been identified that some people were subject to restrictions. The fire safety systems also needed further improvements and evidence that action had been taken was not available. The provider was rated as requires improvement overall. At this inspection we found improvements had been made, however further improvements are needed to recognise where applications to lawfully restrict people’s liberty need to be made.

On this inspection we found people were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People were able to make decisions about their care and staff knew how to respond if people no longer had capacity to make some specific decisions. However, where people were assessed as having capacity, authorisations to deprive them of their liberty had been applied for. Restrictions on liberty can only apply where people lack capacity to make certain decisions. We have made a recommendation about staff training on this subject.

Medicines were now managed to ensure people were protected from the risks associated to them. The number of staff on duty had been reviewed to enable people to receive support when they needed this. Recruitment procedures were in place to check that staff were suitable to work with people.

Risks to people were managed in a safe way and staff knew how to recognise and report potential abuse. Safeguarding procedures were in place and where concerns were identified these had been reported to ensure people’s safety. Accidents were reviewed and improvements were made to prevent further incidents and keep people safe. Infection control procedures were in place and the home was clean.

People felt the staff had the right skills to provide the care they wanted. People had access to health professionals and where advice was given, this was followed. People enjoyed the food and were offered a choice of what to eat and drink. Adapted cutlery and crockery was provided to support people to retain their independence. There were large pictorial signs in the home to help people to recognise different areas and rooms. The communal areas enabled people to have a choice of where to sit and there were hand rails fitted in corridors.

Staff knew people well and people were happy with the care they received. People’s privacy and dignity was promot

This inspection took place on 4 January 2017 and was unannounced. On our previous inspection in March 2016, we found that medicines were not always managed safely; we saw that there was not always enough staff available to deliver people’s planned care and they had to wait for support with personal care. Where people no longer had capacity to make decisions, assessments were not completed accurately to support people to make some decisions for themselves. Applications had not been made to ensure any restriction placed upon people, was lawful. Quality monitoring checks had been carried out although these had not identified where people may be at risk. On this inspection we saw improvements had been made although further improvements were still required.

The service provides support and nursing care for up to 90 older people, some of who may be living with dementia. At the time of the inspection there were 43 people who used the service as the provider was carrying out a refurbishment programme to some parts of the building. The service had four separate units; two nursing units, a general residential unit and a residential unit for people living with dementia.

There was 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 2008 and associated Regulations about how the service is run.

The staffing provided had been reviewed however, when staff were not available, some people were not able to summon support from staff to maintain their safety.

Improvements had been made with how medicines were managed. However, where people were prescribed medicines on an ‘as required’ basis, information was not available to ensure all staff knew when these were needed. Prompt action was not always taken to ensure medicines were administered in a form that people could take. Further improvements were needed.

Staff sought people’s consent before they provided care and support. However, where some people may lack capacity, assessments had not always been completed to ensure decisions were only made by others when they lacked capacity to make decisions themselves. Where people had restrictions placed upon them in the dementia unit to ensure their safety, applications to ensure these were lawful had been made. However, it had not been identified that other people were subject to restrictions. Further improvements were needed.

Quality systems to monitor and improve the quality of care were carried out and identified where some improvements were needed. However the fire safety systems needed further improvements and evidence that action had been taken was not available.

Risks to people were identified and staff knew how to provide support to reduce the risk of preventable harm. Staff understood their responsibilities to protect people from harm and knew how to raise any concerns. Staff received training and support and when they were new to the service; they worked alongside experienced staff and spent time with them so they knew how to provide the care they wanted.

People had opportunities to be involved with a variety of activities and could choose what to be involved with and were treated with kindness, compassion and respect. People liked the staff who supported them and had developed good relationships with them. People maintained relationships with their families and friends who were invited to join in activities with them.

Health care professionals visited the service to provide additional healthcare services to people. Where people needed to have their food and drink monitored, systems were in place to ensure health support was sought promptly to ensure people were well. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professi

We inspected this service on 11 April 2016. This was an unannounced inspection. Our last inspection took place on 24 March 2014 where we found that the provider was meeting the legal requirements.

The service provides support and nursing care for up to 90 older people, some of who may be living with dementia. At the time of the inspection there were 48 people who used the service as the provider was carrying out a refurbishment programme to some parts of the building. The service had four separate units; two nursing units, a general residential unit and a residential unit for people living with dementia.

There was a registered manager in 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.

Medicines were not always managed safely as we saw some people did not receive their medicines if they were asleep. Systems were not in place to ensure people were offered these at a different time and medical advice about their welfare was not sought. Effective systems were not in place to ensure medicines were administered in a consistent and safe manner. Improvements were needed in this area.

There were not always enough staff available to deliver people’s planned care. People did not always receive the support they needed to keep safe and they had to wait for support with personal care. Quality monitoring checks were carried out although these had not identified where people may be at risk from the current staffing provided, or where care records did not include important information. Improvements were needed in this area.

Where people no longer had capacity to make decisions or consent to care, assessments were not completed accurately and had failed to consider that people may still be able to make some decisions for themselves. Applications had not been made for some people to ensure any restriction placed upon people was lawful. Improvements were needed in this area.

People made decisions about their care where they had capacity and staff helped them to understand the information they needed to make informed decisions.

People could choose what they wanted to eat and specialist diets were catered for. Meals were chosen the day before the meal was served but there was no information available for people to remind themselves of the meal options. Simple alternative meals could be provided upon request although if people changed their minds about their food choice, additional food was not prepared to support people to make a meaningful choice at each meal.

Staff received training and support that generally provided them with the knowledge and skills required to work at the service. People living with dementia were not always supported with their specialist needs as staff did not always recognise how to provide this care. Additional activities were not provided to enhance the care of people living with dementia.

Health care professionals visited the service regularly to provide additional healthcare services to people. Staff supported people to attend healthcare appointments and liaised with their GP and other healthcare professionals as required to meet people’s needs.

There was a homely and relaxed atmosphere and people were generally treated with care and compassion. People told us the staff were kind and treated them with dignity and respect. However, some interactions were not dignified as staff did not speak to people when they supported them with personal care or helped them to move.

A range of activities were organised for people during the week and people spoke positively about the opportunities provided. Links had been developed with local volunteer groups who visited people and had helped with the garden areas.

People were

This visit to Haunton Hall was a planned, unannounced inspection. This is the first visit since the registration of the new provider in October 2013. At the time of our visit 46 people were using the service. This was due to refurbishment in some parts of the home which had been closed to ensure there was no disruption to people using the service.

Below is a summary of our finding based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask:-

Is the service safe?

Where risks had been identified, risk assessments were in place with plans of action to inform staff how risks could be minimised.

Sufficient numbers of suitably qualified staff were available to meet people’s needs.

Is the service effective?

Care plans were in place which informed staff how to meet people's needs. People or their relatives told us that they had been involved in the care planning process but this was not always evident in care records seen.

People's views were regularly sought and audits were undertaken to ensure the service was monitored and improved upon for the people using it.

Is the service caring?

We observed positive interactions and conversations between staff and people who used the service throughout the inspection. People told us that they were happy with the care they received and told us that they liked the staff and thought they did a good job.

Is the service responsive?

People's health and care needs were addressed promptly and referrals made to relevant health professionals as required.

People’s preferences and wishes were listened to and acted upon to promote person centred care.

Is the service well-led?

Systems were in place to audit and monitor the quality of the service.

We saw that the management team in place were robust and that staff worked well as a team. Staff told us that they received the support needed to undertake their job and told us that the registered manager was approachable and available to them when needed.