The inspection took place on 13 December 2017 and was unannounced.

When we last inspected the service on the 1 and 3 March 2017. We found that the provider had failed to maintain the health, safety and wellbeing of people in their care and were in breach of Regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014. The service was not consistently well led and there was no registered manager in post. The service was rated as requires improvement overall.

The provider submitted an action plan telling us how they intended to make the required improvements. In addition the provider made a change to their statement of purpose and the service no longer accepts people who live with Dementia. The home has recently undergone a major refurbishment which has greatly improved the living space and environment for people who used the service.

At this inspection we found that the provider had made the required improvements and were now meeting the regulations, and the service has been rated as good.

Houndswood House 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. They are registered to provide accommodation care and nursing for up to 50 people. At the time of our inspection there were 15 people living at Houndswood House.

There was a registered manager in post. 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.

People felt safe living at Houndswood House Staff understood how to keep people safe and risks to people's safety and well-being were identified and managed appropriately. People's needs were met by sufficient numbers of skilled and experienced staff. There was a robust recruitment process in place which helped to ensure that staff employed to provide care and support for people were of good character and fit for the roles they were employed for. People received their medicines regularly from staff who had been trained to administer medicines safely.

Staff received support from the management team which included regular one to one supervision with their line manager. Staff attended regular team meetings which made them feel supported and valued. People received support they needed to eat and drink sufficient quantities to help sustain their wellbeing and people’s health needs were met with appropriate support and access to a range of health care professionals when required.

People and their relatives were consistently complimentary about staff who were kind and caring. Staff were knowledgeable about individuals' support needs and preferences and people and or their relatives had been involved in the planning of their care.

People and their relatives were asked to give feedback about the service they received and their views were taken into account to help drive improvements. People were supported to raise any concerns through the complaints policy and were confident their views would be acted on. Compliments and positive feedback was also captured.

There was a warm open and inclusive atmosphere in the home. Staff had clear roles and responsibilities and felt valued and well supported. The registered manager had worked hard to develop a positive ‘can do’ culture and people were central to everything that happened at the service. The provider had suitable arrangements in place to regularly monitor the health, safety and quality of the care and support people received and had an appetite to make continual improvements.

The inspection took place on 1 March 2017 and was unannounced.

Houndswood House provides accommodation for up to 50 people who require nursing and personal care, including people living with dementia. There are two separate units in the home, Magnolia Lodge for people living with dementia and Primrose House for people who require nursing care. At the time of our inspection there were 30 people living at the home.

There was a support manager who was managing the day to day running of the home. However they were not registered with CQC. The regional manager told us that they were in the process of trying to recruit a new manager who would be registered with CQC. 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.

When we last inspected the service on 4 and 12 October 2016 we found the provider was not meeting the regulations and were in breach of regulations 9, 10, 17 and 18. There were not always sufficient numbers of suitable staff available to meet people’s needs. Governance arrangements were ineffective. Activities were not suited to people’s abilities or interests. People did not receive person centred care and people’s dignity was not always maintained. At this inspection we found that although improvements had been made. Further improvements were required to ensure compliance with the regulations was achieved.

People were unable to tell us whether they felt safe living at Houndswood house. However we observed improvements had been made to help keep people safe. Staff mostly understood how to keep people safe and risks to people's safety and well-being were assessed and were being kept under regular review to help to keep them safe. However staff did not always have access of peoples risk assessment and this put people at risk of injury.

People's medicines were managed safely. They were administered only by trained Nurses who had received training and had their competencies checked.

People had their needs met in a timely way and we observed there were sufficient numbers of staff who had the right skills and experience to support people safely. There was a robust recruitment process in place. This helped to ensure that staff who were employed at the service were suitable to work in this type of service.

Staff received support from their managers. This included both one to one supervision and team meetings. Staff told us they felt supported, although there had been several changes in the management structure which had meant a lack of consistency.

People received the assistance they needed to eat and drink adequate amounts of food and fluid to help keep them well. People were supported to maintain their physical and mental health and staff made referrals to healthcare professionals when required.

We observed staff to be kind and caring. Staff were knowledgeable about people’s individual requirements in relation to their care and support needs and preferences. People and or their relatives had been invited to participate in the planning of their care where they were able to and where this was appropriate.

People were supported to participate in some activities that were provided. However this was an area that required improvements. Activities were not always suited to people’s abilities. Feedback from relatives also indicated that there was less engagement at the weekends and it was not always evident how people who were cared for in their bedrooms were engaged.

People and their relatives were supported to give feedback about the service. People were able to raise any concerns they had and told us that in most cases they were confident they would be listened to and any issues they had would be addressed.

There were systems an

The inspection took place on 04 and 12 October 2016 and was unannounced.

Houndswood house care home provides residential and nursing care for up to 50 older people, some of whom live with dementia. There were 45 people living at the home at the time of this inspection.

There was a registered manager at Houndswood House. 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. We were informed by the provider that after this inspection the registered manager and deputy manager both resigned.

When we last inspected the service on 10, 11, 16 and 18 August 2016 we found the service was in breach of regulations 09, 12, 14, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to ensure that there were sufficient numbers of staff to keep people safe at all times, and people did not always receive personal care in a timely way. The provider had failed to provide people with opportunities for engagement and activities and there were concerns relating to the management of medicines. The provider’s governance and quality monitoring systems also had not been effective in identifying these areas.

Following our inspection in August, we received an action plan to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had not made sufficient and sustainable improvements and further improvements were required. They were found to be in breach of regulations 9, 10,17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During the current inspection we found that people were left in communal areas with no staff present for three separate periods of up to 10 minutes. People were not always assisted or supported in a timely way and they did not always have access to their call bells to enable them to summon assistance when required. Staff had not received the training necessary to give them the skills and knowledge to support people’s individual health conditions, in particular people who lived with dementia. ”People`s nutritional needs were not consistently met by staff.” People were not always supported to engage in daily activities. Engagement was inconsistent and did not provide people with meaningful engagement or stimulation.

The provider had arrangements in place to monitor the quality of the service; however this was not always effective in identifying and addressing areas that fell below the required standards.

People and their relatives were complimentary about the care staff and told us they were kind, compassionate and caring. However, we found that the staff were not always able to spend quality time with people. The care provided was task orientated and did not support a dignified approach for people. The dementia unit was not decorated to reflect best practice for people with dementia offering little to provide stimulation or interest.

The environment in particular on Magnolia unit was 'scruffy' in appearance and was in need of refurbishment in order to provide a dignified home for people to enjoy. The provider acknowledged this and an extensive refurbishment plan was place, the date for commencement of the refurbishment was to be confirmed.

Some of the people told us they felt safe living at Houndswood house care home, however others felt there were not sufficient staff to keep them consistently safe. Staff demonstrated they knew how to keep people safe and risks to people's safety and well-being were assessed and recorded. However these were not always managed effectively. The home was busy at times and staff were struggling to keep people safe.

The provider had a robust r

We carried out this inspection on 10, 11 and 16 August 2016 and we contacted people to obtain further feedback on 18 August 2016. The inspection was conducted in response to concerning information received by the Care Quality Commission. At the previous focused inspection carried out on 7 January 2016 in response to whistle blowing concerns we assessed Safe and Well Led and found breaches of the regulations around people’s safety and the overall management of the service. This was because the provider had failed to put adequate processes in place to keep people safe.

Following the Focused inspection, the provider wrote to us on 18/01/2016 to tell us how they would make the required improvements to meet the legal requirements. At this inspection we found that the provider had failed to make sustainable improvements around the safety and consistency of care and support provided to people.

Houndswood House is registered to provide accommodation and support for up to 50 people with health conditions, age related frailty and people living with dementia. It also provides nursing care. At the time of our inspection there were 46 people living in the home.

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.

We could not be assured that there were adequate numbers of staff on duty to support people safely at all times. People were not always assisted in a timely way and at times people were left alone without any staff present to promote people’s safety and wellbeing.

People appeared unkempt and the support provided for their personal hygiene needs was not of a consistently good standard. People’s beds were not made properly and some had soiled sheets. Slings used to assist people to transfer were shared and some had other people's initials and room numbers on which meant they may have been placed at risk of injury if they were not using the slings that they had been assessed as needing.

Recruitment processes were not always consistent in ensuring staff employed at the service were suitable to carry out their responsibilities and meet people`s needs. For some of whom English was not their first language. We found they did not always understand the questions we asked them or what we were saying to them. The majority of the people who lived at the home had limited communication and therefore it was difficult to fully assess how this impacted on their health and welfare. We also noted that there were inconsistencies in the checks made for example about the validation of references and completion of documentation.

Most of the staff understood how to promote and protect people’s rights and maintain their privacy and dignity. However, we observed several instances where members of staff failed to respect people’s privacy or dignity.

Engagement with activities and hobbies was poor. Loud music was playing from the radio in conjunction with a television. We observed people were uninterested in either option and staff made no attempt to engage with people or offer people alternative choices of activities.

People’s care plans lacked detail or accurate information relating to people’s care and were not subject to regular review. Care plans were not person centred, and did not always contain sufficient detail to ensure they reflected people’s current needs and choices.

People were supported to take their medicines by appropriately trained staff. However, we found the process for the administration of medicines was not consistently safe.

Staff received some support through induction and a training schedule but most of the training was E learning which is training they completed online and was not consistently effe