This inspection took place on 4 July 2018 and was unannounced. At the last inspection the service was rated Good. We inspected this service because we received information giving us concerns about the safety and quality of care. This was a comprehensive inspection.

Living Well Street and Tom Wroe Unit is registered to provide residential care for up to 46 people, some of whom live with dementia. Accommodation is split in to three units, one on each floor of Helme Hall. These are separately called Tom Wroe Unit, Huddersfield Adult Memory Disorders Unit (HAMDU) and Living Well Street. Each floor has separate bathrooms and toilets and communal areas. At the time of the inspection there were a total of 17 people living there. There is a manager based on each unit with an overall manager for the whole service.

Living Well Street and Tom Wroe Unit is a ‘care home’. People in care homes receive accommodation and nursing or 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.

There was a registered manager for the service. There were plans for the registered manager to move to manage a separate part of the service. At the time of the inspection the new manager of Living Well Street and Tom Wroe Unit (who had been in post for four weeks) was not the registered manager but had made an application to be the registered manager. This manager was available throughout our 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.

People and their relatives told us they felt safe living at this service as they were well supported and their health care needs were met. Staff had received safeguarding training and knew how to identify and report signs of abuse.

Recruitment practices were thorough to ensure staff had the suitable characteristics and background to provide care at this service. At the time of the inspection there were sufficient numbers of suitably qualified and competent staff to meet the care needs of people living at the home. However, there had been a high staff turnover prior to the inspection and the registered provider had not ensured there were enough sufficiently trained staff to support people during this time. This meant the provider had failed to plan effectively to ensure effective governance systems were in place. You can see what action we told the provider to take at the back of the full version of the report.

Audits had not identified concerns regarding the storage and administration of medicines. Medicines were not consistently stored safely. A medicine delivery had been left in an unlocked room where a person living at the home found them. Medicines were not administered consistently throughout the home. One unit recorded the application of topical creams on a body map however the two other units did not do this. This meant the provider did not have appropriate systems in place to identify concerns with the administration and storage of medicine. You can see what action we told the provider to take at the back of the full version of the report

The registered provider had recently appointed a workforce development manager and comprehensive training was completed in-house. We saw evidence of staff supervision and appraisals being completed.

People's dietary needs were well managed and there was a good choice of home-prepared food and snacks. Some of the people were supported to buy and prepare their own food. This meant staff were able to accommodate people’s individual preferences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way

Living Well Street and Tom Wroe Unit is registered to provide residential care for up to 46 older people. The home is set over three floors with Living Well Street as a dedicated floor for people living with dementia. Huddersfield Adult Memory Disorder Unit (HAMDU) and Tom Wroe Unit provide care for people living with complex mental health needs.

On the day of this inspection the registered manager was not on site.

At the last inspection, the service was rated as Good. At this inspection we found the service remained Good.

People and their relatives told us they felt safe living at this service as they were well supported and their health care needs were met.

Recruitment practices were thorough to ensure staff had the suitable characteristics and background to provide care at this service.

There were sufficient numbers of suitably qualified and competent staff to meet people’s care needs. Staff received support through an ongoing programme of mandatory and specialist training as well as formal supervision.

People’s dietary needs were well managed.

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.

It was evident from our discussions with staff they had an in-depth knowledge of people's care and support needs.

Care plans were person-centred and focused on a therapy led model of care. A team of psychologists supported the care staff to provide safe and effective care for people. Staff respected people’s privacy and dignity as well as their equality, diversity and human rights.

Quality assurance systems were found to be effective and were used to continuously improve the service. People were able to feedback regarding the service and the registered provider made changes as required.

Further information is in the detailed findings below.

The person named as manager on this report was no longer in post at the time of our inspection. A new manager had been appointed and had started work at the home five days before our inspection.

During our visit to the service we spent time speaking with people who lived at the home, staff working there, the manager and a senior member of management. We looked around the home, observed care, reviewed care files, medication systems and looked at staffing arrangements.

We looked at care files for three people who lived at the home. We saw care plans were in place but found they lacked some detail.

We also identified some areas of care where people had not received the support they needed.

We saw the home used a system of pre prepared meals which, on the day of our visit, were badly prepared and presented. However a senior manager told us they had previously left instruction for the fish and chips meal not to be used and for people to enjoy that meal bought in from a local fish and chip shop. The senior manager assured us that the standard of all other meals from this supplier was very good. They also made arrangements for people who had not enjoyed their meal to be served an alternative.

We found the home unclean in several areas and no immediate action was taken to remedy this.

We found that the systems put in place for managing medicines were good, but some errors had occurred.

We found some issues with the safety of the premises.

We found there were not enough staff to meet people's needs. We saw that care staff treated people with kindness but did not always respond to their needs in a timely manner.

We spoke with six people who lived at the home. Some, due to complex care needs, were not able to tell us their opinions.

One person told us they had enjoyed the cheese and wine party the previous evening. They said they found staff to be kind and caring.

Another person told us their concerns about the home not having a cook from the day after our visit. They said "I don't like the idea cleaners doing the cooking, it's not hygienic." This person also said "Activities nil, I don't like just sitting, everybody just watches the television."

Staff demonstrated a good knowledge of the people who lived at the home. Some told us they would like more training, particularly in caring for people living with dementia. Some staff also expresses their concerns about staffing levels.

The new manager had started work at the service in the week of our visit and was therefore not yet familiar with the home. We spoke with a member of senior management who told us they were aware of some of the issues we had identified and were already working to resolve them.

On the day of the inspection there were thirty three people living at the home and we spoke with seven.

People told us they were happy living at the home and they were looked after well by the staff.

People told us their views were taken into consideration when planning their care and staff respected their wishes and this included their likes and dislikes.

We observed positive interaction between care workers and people using the service and staff spoke with people in a respectful manner.

Comments from people who used the service included;

“The staff are very nice.”

“We are all well looked after here. Staff are good and especially the male carers.”

People told us they had never needed to complain but knew who to speak with if they were not happy.

People told us that the staff were good and they felt well cared for.

People told us that they were able to make choices about how they spent their day and they said that staff were kind and thoughtful.

People told us that entertainers visited regularly however, people also said that on a daily basis not a lot went on at the home. Some people said that they were not bothered about activities each day as they liked to chat with others and also said they enjoyed their own company.

People told us they were visited by the staff before they came into the home and their care was agreed.

Some people living at the home had complex needs and were not able to verbally communicate their views and experiences to us. Due to this we have used a formal way to observe people in this review to help us understand how their needs were supported. We call this the ‘Short Observational Framework for Inspection (SOFI).

During the visit we observed staff providing support to people in a sensitive and dignified way.

Some people told us they were visited by the staff before they came into the home and their care was agreed.

People told us that there were activities taking place each day and it was up to each person if they wanted to join in. The same person said, “The staff are really good, anything we need, we just ask. Could not ask for a better place”.

Another person said, “Its not home, but the next best thing. The staff are lovely”.

People told us they were confident that if they had a concern it would be properly dealt with, and they felt safe.

This inspection took place on 5 and 9 March 2015 and was unannounced. We previously inspected the service on 22 September 2014 and, at that time we found the registered provider was not meeting the regulations relating to care and welfare of people who use services, safeguarding people who use services from abuse, management of medicines, staffing and assessing and monitoring the quality of service provision. We issued warning notices telling the registered provider and the registered manager they must make improvements. The provider sent us an action plan telling us what they were going to do to make sure they were meeting the regulations. On this visit we checked to see if improvements had been made.

Since that time the registered manager has left the service and the registered provider has taken over the day to day management responsibilities. The registered provider has also employed the services of a consultancy firm to support them in making the necessary improvements to the service.

Helme Hall and Helme View Care Home is registered to provide nursing and residential care for up to 46 people. Although registered to provide nursing care, the home is not currently offering this provision. The home is set over two floors with the first floor being a dedicated unit for people living with dementia. At the time of our visit there were four people living on the ground floor unit and fourteen on the living with dementia unit.

At the time of our visit there was no 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. The registered provider has been actively involved in trying to appoint a manager since our last inspection and in the meantime has taken on this responsibility themselves.

We found that the registered provider had taken sufficient action to meet with the breaches of regulation we identified during our inspection in September 2014.

People told us they felt safe and staff knew how to maintain people’s safety. Personal emergency evacuation plans were in place.

The home was clean and staff followed good routines in relation to infection control. An infection control champion had been appointed from within the care staff.

Staff received good levels of training and support and treated people with kindness and respect. People told us they were well looked after. A dignity champion had been appointed from within the care staff.

Staff respected people’s right to make choices and knew how to support them in this. People received a nutritious diet and found the food enjoyable although some people did not receive the consistent support they needed with their meal. A diet and nutrition champion had been appointed from within the care staff.

The environment of the living with dementia unit had been improved. Small areas had been created throughout the unit for people to sit quietly enjoying music, reading materials or other items of interest left in place for people to interact with. A dementia champion had been appointed from within the care staff.

Improvements had been made to the environment of the residential care unit.

Care planning had improved since our last inspection and plans were in place for further development. Particular attention had been given to the care plans for people living with dementia to make sure staff understood how to support them effectively.

Activities were provided but this was not at a level which would meet the needs of all the people living at the home.

Robust processes were in place for auditing the quality of service provision.