The inspection took place on 4 October 2017 and was unannounced. At the last inspection on the 7 September 2016, the service was rated as requires improvement in every key line of enquiry we inspect against and had three breaches: Regulation 9. Person centred care. Regulation 18. Staffing and Regulation 17. Good governance. At the last inspection, there was a manager newly in post who has since been registered with the Care Quality Commission.

At our most recent inspection, we identified improvements in all areas although there were still some concern about staffing levels and whether there was sufficient skill mix on shift. Staff recruitment remained a difficult area for this service and for the care sector in general.

The service is for older people who require residential care, some of whom may be living with dementia. The home could accommodate up to 74 people in single, en-suite rooms. Accommodation was over two floors with the dementia unit on the ground floor. On the day of our inspection there were 70 people using the service.

There was 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.

We found the home had improved and had worked hard to meet its own action plans. The home was well led and the staff we spoke with were very professional, knowledgeable and provided care centred around the needs of each individual. At the last inspection, we reported on a breach of regulation in regards to staffing levels. At this inspection there were enough staff to provide care people needed in a safe way. However, we saw there were difficulties around the recruitment and retention of staff and agency staff were being regularly used. Ensuring there were staff with sufficient skills and experience was also a challenge for the service given a recent vacancy of unit leader and only a small number of senior staff who could lead and direct the shift.

Staff spoken with were familiar with safeguarding protocols and how to protect people as far as reasonably possible from abuse. The home was proactive in reporting any concerns of alleged or actual abuse. They told us they reported anything of concern and brought it to the attention of the local authority. They worked with other agencies to try to support people with their anxieties and distressed behaviours. We received feedback about this and were told that a consistent approach was not always used and the guidance in people’s care plans not always sufficiently detailed to support staff to work in a consistent way. We observed staff and found their approaches consistent and calm in the way they approached people.

Medicines were well managed and people received them as intended. We identified an issue with recording but were given immediate assurances that this would be addressed.

Risks to people’s safety were managed well and there were enough staff to deliver care as needed. There was sufficient management oversight of risk. This helped ensure people received safe care and treatment.

Robust staff recruitment processes were in place and helped recruit staff with the right attitude and skills for the job

Staff were supported through induction, training and ongoing support to help develop their confidence and competencies. A lot of staff had transferable skills and qualifications from their country of origin. For staff new to care, a nationally recognised induction, the care certificate, was used by way of introduction and covered all the key skills and competencies.

People were supported according to their preferences but engagement with people, their relatives and staff in the planning of care needed further consideration. Staff acted lawfully in terms of supporting peopl

Iceni House provides accommodation and personal care for up to 74 older people, some of whom may be living with dementia. There were 67 people living in the home on the day of our inspection.

This inspection took place on 7 and 9 September and was unannounced on both days.

The previous registered manager had left the home in May 2016. A new manager had been appointed who had previously been working at the home as the deputy manager. They were in the process of completing a CQC registered manager’s application. 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 2008 and associated Regulations about how the service is run.

At the last inspection the home was rated good in each of the key questions is it ‘safe’, ‘caring’, ‘responsive and well led. We rated the key question of ‘effective’ as requires improvement. However the home was rated good overall. At this inspection the home has been rated requires improvement in each of the key questions and overall. This means that there were more concerns at the home now than at the previous inspection.

The provider had a recruitment procedure in place; records did not however reflect that this was always followed when new staff were recruited. Staff were not always supported in their role through regular training and supervision.

There were insufficient numbers of staff on duty. Staff were not always deployed effectively in order that they could meet people’s needs effectively.

Infection control monitoring within the home was in need of improvement. Staff did not always follow safe procedures to protect people from the risk of cross infection.

Staff had not always received the required training to enable them to meet people’s needs. Staff were not familiar with the principles of the Mental Capacity Act 2005 (MCA).

People received support from staff that were mainly kind and caring. However, people were not always treated with dignity and respect because staff were task focussed and care took place in a manner that was not centred on them with hurried or little interaction.

There were systems in place for managing medicines in the home. A medicine procedure was available for staff and staff had completed training in relation to safe medicine administration. Medicines were stored safely and records showed they were administered as prescribed. Healthcare professionals such as chiropodists, opticians, GPs and dentists were involved in people's care when necessary.

People were supported to maintain a healthy balanced diet. Dietary and nutritional specialists' advice was sought so that people with complex support needs with their eating and drinking were supported effectively. Records of support provided however did not always show that this care had been delivered.

We found the home was in breach of three regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on 11 and 20 February 2015 and was unannounced. Iceni House is a residential care home providing personal and nursing care and support for up to 74 older people, some of whom may live with dementia.

The home had a registered manager who has been in post since 2011. 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 told us they felt safe and that staff supported them in a way that they liked. Staff were aware of safeguarding people from abuse and they knew how to report concerns to the relevant agencies. Individual risks to people were assessed by staff and reduced or removed.

There were usually enough staff available at most times to meet people’s needs. However, there were times when people had to wait for care.

Medicines were safely stored and administered, and staff members who administered medicines had been trained to do so.

Staff members received other training, in a variety of formats, which provided them with the skills and knowledge to carry out their roles. Staff received support from the manager, which they found helpful, although they did not always have the opportunity to discuss individual performance needs.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The service was not meeting the requirements of DoLS. The manager had not acted on the requirements of the safeguards to ensure that people were protected.

Staff members understood the MCA and presumed people had the capacity to make decisions first. However, where someone lacked capacity, best interest decisions to guide staff about who else could make the decision or how to support the person to be able to make the decision was not easily available.

People enjoyed their meals and were given choices about what they ate. Drinks were readily available to ensure people were hydrated.

Staff members worked together with health professionals in the community to ensure suitable health provision was in place for people.

Staff were caring, kind, respectful and courteous. Staff members knew people well, what they liked and how they wanted to be treated.

People’s needs were responded to well and care tasks were carried out thoroughly by staff. Care plans contained enough information to support individual people with their needs.

A complaints procedure was available and people were happy that they did not need to make a complaint.

The manager was supportive and approachable, and people or their relatives could speak with him at any time.

The home monitored care and other records to assess the risks to people and ensure that these were reduced as much as possible. There had been a recent change in provider and we were not able to look at how well the home was run over a period of time. We will look at this at our next inspection.

We have made a recommendation about staff supervision.