About the service: Keresley Wood Care Centre provides accommodation, nursing and personal care for up to 47 older people. At the time of our visit 27 people lived at the home. Accommodation is provided in a two-storey adapted building. The home is located in Coventry, West Midlands.

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

People’s experience of using this service:

•There were not enough staff on duty to ensure the delivery of safe care in line with people’s assessed needs.

•Managerial oversight of the service did not support continuous improvement or ensure people received safe individualised care.

•People felt safe but risks associated with people’s care were not well-managed.

•Systems to monitor the quality and safety of the service were not effective.

•Lessons learnt when things had gone wrong had not always been clearly communicated to staff.

•Medicines were not always managed safely.

•The environment was clean, and staff followed good infection control practices.

•People’s dignity was not maintained. Staff respected people’s privacy and supported people to be independent.

•Staff were recruited safely and received on-going support and training to be effective in their roles.

• People had individualised care plans. However, some did not contain clear information. Daily records were not accurate and did not assure us people received care in accordance with their needs and wishes.

•People’s needs had been assessed before they moved into the home to make sure it was the right place for them to live. People and relatives were involved in planning and reviewing care.

•People received information about the service in a way they could understand and had some control over how to live their lives.

•Staff had a good knowledge of people’s dietary needs. People enjoyed their meals, and their dietary needs were catered for. However, the meal time experience was not positive.

•Staff cared about people but did not have time to provide person centred care.

•Activities were provided but improvement was needed to ensure people were not socially isolated.

•People received timely support from healthcare professionals.

•People, relatives and staff were encouraged to share their views about the service. Some feedback was used to drive improvement.

•People, relatives and staff spoke positively about the registered manager.

•Complaints were not managed in line with the provider’s procedure.

Following our inspection, we notified relevant stakeholders such as the Local Authority Quality Team about the areas of concern we identified.

We reported that the registered provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were:

Regulation 12 Regulated Activities Regulations 2014 - Safe care and treatment

Regulation 17 Regulated Activities Regulations 2014 - Good governance

Regulation 18 Regulated Activities Regulations 2014 – Staffing.

Rating at last inspection: At the last inspection the service was rated as ‘Requires Improvement’ (The last report was published 20 April 2018).

This is the fourth consecutive time the service has been rated ‘Requires Improvement’.

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 6 March 2018 and was unannounced.

Keresley Wood Care Centre is a ‘care home' with nursing. 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. The home provides nursing care to a maximum of 44 people. Sixteen people lived at the home on the day of our inspection.

The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge and dining room, and bedrooms. The first floor has bedrooms only.

The home had 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. The registered manager had worked for the service for four months at the time of our inspection visit.

We last inspected the home on 22 March 2017. The home was rated as ‘requires improvement'. Since our inspection in March 2017, the home had been through another period of instability. The manager and deputy manager present at our last inspection left the service, as did a high number of staff. This meant the improvements made at our last inspection were not sustained, and there was a further dip in the quality of care people experienced. The provider worked with the commissioners of the service and with the CQC in providing information about how they were managing and improving the situation.

A new registered manager and deputy manager were now in post. We received positive comments about their management style, and saw stability was returning to the home, with relatives becoming more confident they would address any concerns raised; and staff feeling more supported.

Whilst there had been a high level of staff vacancies since our last inspection, and therefore a high level of agency staff usage; at the time of our visit this was significantly decreasing, and the home was beginning to enter a more stable period. There were sufficient staff on duty to meet people's needs.

There had been concerns since our last visit that risks to some people's health and well-being had not been managed well. The new management team had worked hard to improve risk assessments and to monitor and act on identified risks.

New and existing staff had received training to support their roles and responsibilities. Newly recruited mental health nurses were in the process of receiving training to improve their responsiveness with general nursing needs.

People had access to other healthcare professionals when required. Medicines were managed safely and people received their medicines when they should.

The clinical support provided to people had improved, but the home was less responsive in providing social and emotional support to people. Activities were provided but these did not seem to reflect people's interest or hobbies.

The registered manager was open to listening to concerns or complaints about the service and responded to individual complaints in accordance with the provider's policy and procedures. People had the opportunity to discuss their views at monthly resident and relatives meetings.

People enjoyed their meals. People at risk of malnutrition and dehydration were provided with sufficient support to reduce this risk.

Staff were kind and caring to people, and had a desire to make sure people received good care. They respected people's dignity and privacy.

The provider recognised the importance of respecting people's human rights, and the promotion of equality and diversity in the home. The registered manager and staff understood and complied with the Mental Capacity Act regulations and Deprivation of Liberty safeguards.

This inspection took place on 22 March 2017. It was unannounced.

Keresley Wood Care Centre is a nursing home which provides nursing care to a maximum of 44 people. 19 people lived at the home on the day of our inspection. The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge/dining room and bedrooms. The first floor has bedrooms only.

At the time of our visit the home did not have a registered manager. The previous registered manager resigned in October 2016. 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 manager subsequently registered with the CQC in June 2017.

At our last inspection visit in May 2016 we found that the provider was not meeting the required standards. We identified two breaches in the legal requirements and regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was not enough staff to meet people’s needs and that care delivered was not person centred.

Following our last inspection we asked the provider to send us an action plan outlining the improvements they intended to make. At this inspection we found improvements had been made however one care plan did not reflect changes in a person’s care needs. The manager addressed this during our inspection visit.

People who lived at Keresley Wood Care Centre and the staff who supported them, thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm.

We observed, and people told us, staff members were caring and however we received mixed opinions about if staff had enough time to spend with people that was not task focused.. People had access to call bells and these were responded to promptly by staff.

Staff received training the provider considered essential which provided them with the skills and knowledge to provide effective care to people. Staff understood how to support people who did not have capacity to make decisions for themselves and relatives were involved in this process.

People received a choice of food and drink which met their nutritional needs. We saw staff supported people to eat and drink and we saw people were offered drinks throughout the day. Records related to people’s food and fluid intake were in place in order to ensure their health and well-being were being maintained.

People were supported to maintain good health. We saw some appropriate referrals were made to specialist healthcare professionals when people needed support, for example with eating and drinking and promoting good skin care.

Care plans and risk assessments contained information that supported staff to meet people’s needs. People and their relatives were not consistently involved in reviewing the care that was provided.

Staff treated people with kindness and respected their dignity . Most people were happy about the activities available in the home however the manager acknowledged they could be better tailored to individual interests, especially for people who were cared for in bed. The manager was reviewing the activities offered by the home to improve this.

People and relatives were encouraged to share their views about the home and people were aware of how to make complaints. When a complaint was received the manager investigated it in line with the home’s complaints procedure.

Staff felt supported by the manager and felt the provider had invested a lot of time into helping the home improve however this had been limited by a number of changes in managers.

This inspection took place on 25 May 2016. It was unannounced.

Keresley Wood Care Centre is a nursing home which provides nursing care to a maximum of 44 people. Forty three people lived at the home on the day of our inspection. The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge/dining room and bedrooms. The first floor has bedrooms only.

The home has 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 refer to them as the manager throughout this report.

At our last inspection visit in January 2015 we found the registered manager had not sent all statutory notifications required to us and this was a breach of regulation. These were notifications to inform us of deaths and incidents that affect the health, safety and welfare of people who live at the home.

Following our last inspection we asked the provider to send us an action plan outlining the improvements they intended to make. At this inspection we found improvements had been made however two notifications we received were not completed in detail and referrals to the local safeguarding authority were not made. The provider had addressed this prior to our inspection visit.

People who lived at Keresley Wood Care Centre and the staff who supported them, thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm. However, everyone we spoke to at the home told us there were insufficient numbers of care staff to provide care and support to people at the times they needed it.

Some people and relatives were unhappy with the care provided and expressed concerns about the length of time they, or their relations, had to wait to receive care. Staff were committed to providing a good standard of care but we observed there were delays in attending to the personal care needs of people. People did not consistently receive baths and showers when they wanted them and there were delays in people being assisted to use the toilet.

We observed, and people told us, staff members were caring but did not have time to interact with people unless they were providing personal care and we saw some people were left for long periods with little interaction. Call bells were not always in people’s reach when they needed to request support from staff.

Staff did not consistently receive support from the provider and manager to enable them to provide effective care to people. Only 50% of staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). There were policies and procedures in place to ensure that people who could not make decisions were protected, however we found appropriate assessments had not always been completed in detail. This was being addressed by the provider and training was taking place on the day of our inspection.

We saw people received a good choice of food and drink, and people’s nutritional needs were met. We saw that staff supported people to eat and drink, however some people told us drinks were not always available when they wanted them. Records related to people’s food and fluid intake were not in place in order to ensure their health and well-being were being maintained.

People’s health needs were met. We saw some appropriate referrals were made to specialist healthcare professionals where people needed support, for example with eating and drinking and skin breakdown.

Care plans and risk assessments contained information that supported staff to meet people’s needs. However some had not been updated when there had been change in people’s care needs and some initial assessments of p

This inspection took place on 7 January 2015. It was unannounced.

Keresley Wood Care Centre is a nursing home which provides nursing care to a maximum of 44 people. Forty people lived at the home on the day of our inspection. The home operates on two floors. The ground floor accommodation consists of a lounge, a dining room, a larger lounge/dining room and bedrooms. The first floor has bedrooms only.

The home has 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. At the time of our inspection the registered manager was on a long term absence from the home and the provider had put plans in place to provide management cover. The deputy manager had been acting as the manager since December 2014.

The registered manager had not sent all the statutory notifications required to us. These are notifications to inform us of deaths and incidents that affect the health, safety and welfare of people who live at the home.

Staff received support from the provider and acting manager to enable them to provide effective care to people. Staff had received training in the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS), however we were concerned that the DNACPR and advanced decisions to refuse treatment did not meet the requirements of the Act.

There were systems in place to ensure the premises and equipment were well maintained. Not all emergency procedures were up to date or understood by staff.

People who lived at Keresley Wood Care Centre and the staff who supported them, thought people who lived at the home were safe. There were systems and processes in place to protect people from the risk of harm.

We saw people received a good choice of food and drink, and people’s individual food requirements were well catered for.

People’s health needs were well met. They were referred to the appropriate health care professional when concerns about their care and well-being were identified.

Staff treated people with kindness. Staff had a good understanding of people’s needs and supported people with respect and ensured people’s dignity was maintained. People felt comfortable in expressing their views to staff and were actively involved in day to day decisions in the home.

The provider employed an activity worker to support people with their activities, hobbies and interests. People had access to group activities, and the activity worker helped them with individual interests.

Staff had previously expressed concerns about the management of the home. At the time of our visit, this was being addressed by the provider.

You can see what action we told the provider to take at the back of the full version of the report.

During our visit to Keresley Wood Care Centre we spoke at length with three people living at the home, one relative, and five staff. We spoke more briefly with four other people living at the home.

People we spoke with told us they liked living at Keresley Wood. They told us staff were kind, and treated them with respect and dignity. One person told us, “Everyone is friendly…they’ll sit and listen”. This was echoed by a relative who said, “It’s great. The staff are so friendly…we’ve nothing but praise”.

We looked at care and consent to treatment. We saw that good care was provided. People and their families were fully involved in the decisions made about the way care was provided.

We looked at how the service recruited its staff. We saw that recruitment practice ensured staff were appropriately qualified and were safe to work with people living at Keresley Wood.

Staff told us they enjoyed working at Keresley Wood. One staff member said, “Everyone is brilliant, the company have supported me to do the job well”.

We looked at the administration of medicines at the home. We were satisfied that medicines were administered safely.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by a second inspector and an Expert by Experience; people who have experience of using services and who can provide that perspective.

To help us understand people's experiences we used the Short Observational

Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences of people who could not talk with us.

We spoke with eight people who lived in the home about their experience of living at Keresley Wood. We spent time talking with staff and the assistant manager of the home. We also spoke with two relatives who were visiting while we were there. To help us understand the experiences of people who could not talk with us we spent some time observing how people were cared for and supported.

People we spoke with said that staff treated them well and that their privacy and dignity was respected. One person said, “They are always helpful. In a place where everyone is so different, they are very patient.”

People told us that they can make choices in relation to daily living and mealtimes. One person told us, “I get up when I am ready and have breakfast when and where I want to.”

People we spoke with told us that they enjoyed the food and choices were available to them. One person told us, “It’s nicely served, you have a choice. At tea time you can have soup, jacket potatoes, fish on toast and a choice of sweet such as jelly.”

People told us they had no concerns about the care and support they received. People we spoke with said that the home was a nice place to live. One person said, “It is a happy place”.

People who lived in the home told us that staff were available if they needed anything. One person told us,” Staff are usually busy but they always make time for you”. One relative told us “I am satisfied with the care Mum receives, the staff are all kind and she is looked after here. I do think there could be more staff at times”.