About the service: Inglewood care home is a care home for up to 48 people aged 65 and over who require nursing or residential care. At the time of inspection, 31 people were using the service.

People’s experience of using this service and what we found: People and their relatives told us they were happy with the care and support which they received. They told us the overall quality of the service had improved and spoke highly of the interim manager. Staff were supported in their roles and were committed to working at the service.

There were gaps in some of the maintenance records reviewed. The number of accidents and incidents had reduced. Staff lacked confidence in managing incidents and felt that further training was needed. Safeguarding alerts had been raised when needed and appropriate action had been taken by the provider and interim manager. Some staff had limited knowledge in the application of safeguarding. There was evidence that lessons had been learned since the last inspection and following safeguarding incidents.

Quality assurance measures had been completed more robustly and action plans were in place. Staff were committed to the improvements put in place and understood time was needed to embed the improvements. Feedback was sought and used to promote change. Everyone spoken with told us significant improvements had taken place at the service and felt that this had positively impacted on the overall care which people received.

Good processes were in place to safely recruit staff. There were enough staff on duty. Medicines were safely managed, and action plans were in place to make continued improvements. The service was clean and tidy.

Improvements had been made to the assessment process. Staff were supported in their roles. Supervision and appraisals were more routinely carried out. Training was up to date.

People received a diet in-line with their needs. Robust monitoring was in line for people at risk of malnutrition and dehydration. Records for monitoring weight and dietary intake had significantly improved.

Staff were responsive when people’s needs changed. Referrals to health professionals for additional support had been carried out when needed. Significant improvements had been made to the environment, with further planned improvements in place.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Although people were given choice and staff sought people’s consent, some staff knowledge of the Mental Capacity Act and people subject to Deprivation of Liberty Safeguards was limited.

Staff treated people and their relatives with kindness and respect. Staff knew people well and included people into all aspects of their care. People’s privacy and dignity was always maintained. All staff worked together as a team to deliver good care to people. Relatives were made welcome and kept informed.

People received the care which they needed and told us they were happy with the care provided. Care records were significantly improved. Staff were up to date with people’s care needs and communicated with each other when people’s needs changed. People, relatives and staff spoke highly of the new activities for people.

Everyone knew how to raise a complaint if they needed to and told us the interim manager was approachable and felt able to raise a concern with them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The overall rating was Requires Improvement, (Published 25 December 2018). This was the third consecutive time the service had been rated Requires Improvement.

At the last inspection we identified breaches in relation to safe care and treatment, respecting and maintaining people’s dignity, nutrition, the premises, quality assurance, staffing levels and support for staff by way of supervision, appraisal and training. We issued a notice of decision to r

We completed this unannounced focused inspection on 17 October 2018.

Inglewood care home is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Inglewood care home is a purpose-built care home in a residential area of Redcar and Cleveland. The service provides residential and nursing care and support for up to 48 older people, some of whom lived with dementia or a physical health condition. Bedrooms and communal areas are provided over two floors. Each person has access to an en-suite bedroom and there are gardens to the rear of the service. At the time of the inspection, there were 35 people using the service.

The manager had been in post since November 2017, but had come a registered manager on 20 August 2018. 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.'

Inglewood care home is an established care home, however was newly registered under Crystal Care Services Limited on 12 July 2017.

We completed an unannounced comprehensive inspection of this service on 3, 9 and 11 July 2018. We found the service was not meeting the Health and Social Care Act 2008 (regulated activities) regulations. Staff were not safely managing the overall risks to people. People were not supported with their nutrition and hydration increasing the risk of harm. There were insufficient suitably trained staff on duty. Medicines were not managed safely. Infection prevention and control procedures were not always followed and the environment needed to be updated. Robust systems for determining people’s capacity was not in place. The quality of all records reviewed need to be updated. An ineffective system of quality assurance was in place.

After the inspection, we wrote to the provider to outline our concerns about the service and asked them to provide us with an immediate action plan about the improvements they were going to make to become at least Good. We asked the provider to share an updated action plan each month to allow us to monitor the progress the service was making. We also issued a notice of decision to restrict admissions into the service.

We rated the service to be Requires Improvement at the last inspection. In line with our guidance, we met with the provider, registered manager, Redcar and Cleveland local authority, Middlesbrough local authority and South Tees Clinical Commissioning Group (CCG) to discuss the action the provider was going to take to become at least Good.

Since the last inspection we received concerns in relation to suitably trained staff, nutrition, hydration and leadership. As a result, we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (location's name) on our website at www.cqc.org.uk.

At this inspection on 17 October 2018 we identified that some progress had been made to improve the overall quality of the service. However, further work still needed and the changes in place needed to be sustained. The Notice of Decision imposed upon the service to restrict admissions without our approval remained in place.

There were shortfalls in all areas of training, supervision and appraisal. Planned dates were in place for some areas of training.

People who required a pureed diet because of the risk of choking now received one. Menu’s needed to be improved to ensure people were receiving variety and fruit and vegetables in line with national guidance. People who needed

Inglewood care home is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Inglewood care home is a purpose-built care home in a residential area of Redcar and Cleveland. The service provides residential and nursing care and support for up to 48 older people, some of whom lived with dementia, Parkinson’s disease or a physical health condition. Bedrooms and communal areas are provided over two floors. Each person has access to an en-suite bedroom and there are gardens to the rear of the service. There were 43 people using the service on the first and second day of the inspection and 39 people on the third day of the inspection.

A registered manager had not been in post since 29 September 2017. A manager was in post on the days of inspection and they had started their employment in November 2017. They had submitted an application to become a registered manager four days prior to the 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.’

Inglewood care home is an established care home, however was newly registered under Crystal Care Services Limited on 12 July 2017. Inglewood care home had been in breach of health and social care regulations since 2014. Although a new provider was in place, further concerns were identified at this inspection about the safety of people using the service.

At the last inspection on 4 April 2016, we found improvements were needed to the quality assurance of the service. We asked the provider to complete an action plan to show us the improvements they planned to make, including timeframes.

There were insufficient staff on duty to provide safe care and support to people. Staff were unable to meet people's needs. Health and safety checks of people were not regularly carried out when needed because staff did not have time. They had been incidents where people had hit other people. This meant people were at risk of harm from the behaviour of other people. The systems in place had not safeguarded people from harm. Care records were not routinely updated when incidents took place. Practices in place to ensure lessons were learned were not effective.

Staff understood the different types of abuse. However, staff did not recognise that their failure to manage the risks to people and keep them safe, placed people at increased risk of physical abuse, organisational abuse and neglect. Improvements to medicines were needed. There were gaps in records and medicines were not always available when people needed them. Infection prevention and control procedures were not followed.

People who needed an adapted diet because of their nutritional needs and swallowing risks did not receive the correct diet or hydration. Records did not clearly indicate the correct diet and fluids which people needed. Staff knowledge was poor. People with adapted diets did not have a choice of meal. Records of the food and drinks people had consumed were not up to date or reviewed to make sure people’s intake was sufficient.

Staff were not supported with regular reviews during their induction. Supervision, appraisals and training were not up to date. People did have access to health and social care professionals, however guidance from them was not always followed or clearly presented in care records.

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. Staff worked in line with the Mental Capacity Act 2005. Howe