This inspection was completed on 6 and 7 February 2108 and was unannounced.

Keychange Charity Sceats Care Home is a ‘care home’. The service will be referred to as Sceats Care Home throughout this report. 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. Sceats Care Home accommodates 30 people in one adapted building. There were 19 people at Sceats Care Home at the time of the inspection.

There was a registered manager in post at the service. 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run

The previous inspection was completed in September 2016 and the service was rated Requires Improvement overall. The service had not fully completed their action plan in relation to the planned improvements to the environment in the home, people did not receive sufficient activities and systems to continually monitor the effectiveness of the service had not been fully embedded. At this inspection, we found improvements had been made and the service was rated Good.

People received safe care and treatment. Staff had been trained in safeguarding and had a good understanding of safeguarding policies and procedures. The administration and management of medicines was safe. There were sufficient numbers of staff working at the service. There was a robust recruitment process to ensure suitable staff were recruited. Risk assessments were updated to ensure people were supported in a safe manner and risks were minimised. Where people had suffered an accident, themes and trends had been analysed, and action had been taken to ensure people were safe and plans put in place to minimise the risk of re-occurrence.

Staff had received training appropriate to their role. People were supported to access health professionals when required. They could choose what they liked to eat and drink and were supported on a regular basis to participate in meaningful activities. People were supported in an individualised way that encouraged them to be as independent as possible. People were given information about the service in ways they wanted to and could understand.

People and their relatives were positive about the care and support they received. They told us staff were caring and kind and they felt safe living in the home. We observed staff supporting people in a caring and patient way. Staff knew people they supported well and were able to describe what they liked to do and how they liked to be supported.

The service was responsive to people’s needs. Care plans were person centred to guide staff to provide consistent, high quality care and support. Daily records were detailed and provided evidence of person centred care. People received end of life care and support which met their individual needs and preferences.

The service was well led. People, staff and relatives spoke positively about the registered manager. Quality assurance checks were in place and identified actions to improve the service. The registered manager sought feedback from people and their relatives to continually improve the service.

Keychange Charity Sceats Care Home provides accommodation and personal care for up to 30 older people. At the time of our inspection 17 people were using the service.

This was a comprehensive inspection to follow up on our previous inspections carried out in April and June 2016. Our visit was unannounced meaning the provider and staff did not know we would be coming.

Keychange Charity Sceats Care Home was placed in ‘special measures’ by CQC as a result of our inspection in April 2016. In June 2016 we saw some improvements had been made. Following this inspection, in September 2016, the service is no longer in ‘special measures’.

There was no 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. The provider had appointed a manager who had applied to CQC to become registered manager.

From speaking with people, relatives, staff and other health and social care professionals it was clear that the improvements we noted in June 2016 had been built upon. The provider, manager and staff had demonstrated a desire to improve the service provided and achieved considerable success. The improvements we have reported on now need to be sustained.

People received a service that was safe. Staff understood their role and responsibilities in keeping people safe from harm and knew how to raise any concerns. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Medicines were well managed and people received their medicines as prescribed. Infection control measures were in place.

Staff received regular training and the support needed to meet people’s needs. People were supported to make choices and decisions. People had enough to eat and drink. Arrangements were made for people to see their GP and other healthcare professionals when required. People’s healthcare needs were met and staff worked with health and social care professionals to access relevant services. A programme of works to improve the living environment had begun. The provider had plans in place to complete these works. The provider needs to ensure these are completed.

People received a service that was caring. They were cared for and supported by staff who knew them well. Staff treated people with dignity and respect. People were supported to maintain relationships with family and friends.

People received person centred care and support. People were encouraged to make their views known and the service responded to this by making changes. However, there were not enough activities offered to people.

Significant changes had been made to the management of the service since April 2016. These had resulted in an improvement to the leadership and management. The provider and manager had developed and implemented their action plan following our inspections in April and June 2016. The provider now had systems for checking on the quality of the service provided. They had worked positively with other health and social care professionals to achieve a change in culture which had improved how the service was delivered. The improvements made now need to be sustained and the provider must ensure consistent and effective leadership and management is in place.

Keychange Charity Sceats Care Home provides accommodation and personal care for up to 30 older people. At the time of our inspection 18 people were using the service.

At our comprehensive inspection of this service on 8, 12 and 13 April 2016 we identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We issued the provider with three warning notices and one requirement stating they must take action. We shared our concerns with the local authority safeguarding and commissioning teams.

This announced inspection was carried out to assess whether the provider had taken action to meet the warning notices we issued. We will carry out a further unannounced comprehensive inspection to assess whether the actions taken in relation to the warning notices has been fully implemented and sustained, to assess whether action has been taken in relation to the requirement made at the last inspection, to assess whether action has been taken in relation to the requirement made at this inspection and provide an overall quality rating for the service.

This report only covers our findings in relation to the warning notices we issued. We have amended the ratings since the inspection on 8, 12 and 13 April 2016. The overall rating for this service is now ‘Requires Improvement’. However, the service remains in ‘special measures’ until we carry out a comprehensive review. This will allow us to see if the improvements made have been sustained and to look at each of our five key questions.

The purpose of special measures is to:

- Ensure that providers found to be providing inadequate care significantly improve.

- Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action. You can read the report from our last comprehensive inspection by selecting the 'all reports' link for Keychange Charity Sceats Care Home on our website at www.cqc.org.uk.

There was no 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. The previous manager of the service had left on 13 May 2016. They had not been registered with CQC. An acting manager was in place. The provider was in the process of recruiting a new manager for the service. The registered provider assured us that once appointed; the manager would be supported to apply for registration with CQC as soon as practicable.

At this inspection we found that the provider had taken action to address most of the issues highlighted in the warning notices. However, we identified one area where the required action had not been taken. Risk assessments were not always in place and those that were lacked sufficient detail to safely provide care. The provider had a plan for completing the required action. We will check to ensure this action is taken.

The provider had ensured pre-employment checks were carried out to ensure staff were safe to provide care to vulnerable people. The premises and equipment were safe for people to use. Systems were in place to protect people from the risk of infection. These improvements must now be sustained.

Staff received training on caring for people living with dementia and providing end of life care. The provider had plans in place to ensure training was provided to all staff with updates when required. Staff received individual supervision with their supervisor. These improvements must now be sustained.

Significant changes had been

Keychange Charity Sceats Care Home provides accommodation and personal care for up to 30 older people. At the time of our inspection 18 people were using the service.

This inspection was unannounced and took place on 8, 12 and 13 April 2016.

There was no 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. The manager registered with the Commission left the provider’s employment some time ago. A manager has been employed since October 2015 but has not yet registered with CQC.

Our inspection highlighted shortfalls where some regulations were not met. We also identified areas where improvement was required and made recommendations that the service should adopt.

People did not receive a service that was safe. Risk assessments were not always in place and those that were lacked sufficient detail to safely provide care. Staff did not receive regular training on keeping people safe and were not familiar with safeguarding procedures. Pre-employment checks to ensure people were safe to work with vulnerable people were not always carried out before staff started work.

The service did not provide effective care and support. Staff had not received training on caring for people living with dementia or receiving end of life care. Newly appointed staff had not received basic training required to provide effective care to people. Staff were not receiving regular supervision. The service was not adhering to the principles or requirements of the Mental Capacity Act 2005 (MCA) or Deprivation of Liberty Safeguards (DoLS).

People did not always receive a caring service. Staff did not always give people the care and attention they wanted or needed. People generally spoke positively about the staff caring for them. Care staff did not know the people they were caring for well.

The service was not responsive to people’s needs. Care plans were not person centred and lacked the detail required to provide consistent, high quality care and support. Daily records were not completed thoroughly. There were not enough activities for people. People’s views regarding their care were not actively sought.

The service was not well-led. The manager had been in post since October 2015 but had not submitted an application to register with CQC. The ratings from our inspection on 15 and 16 June 2015 were not on display at the service. The operations manager and manager said they would ensure ratings were displayed with immediate effect. Quality checks were not in place to assess the quality and safety of the service and plan for improvements. The provider had written an action plan for improvements they planned to make. However, this plan showed no prioritisation and timescales for completion did not appear realistic.

We found a number of breaches 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.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.

When we visited we spoke to the registered manager, two care staff, a relative and three people living in the home. We also observed how some of the staff engaged with people. A relative told us, "the home is much brighter now and there is a beautiful new lounge. There is enough staff and staff know how to treat people with dementia". People living in the home told us, "it's very nice indeed living here, the staff are kind and respectful" and "it's good here the food is excellent and the staff are good".

We found that people had detailed care plans and had been referred to health and social care professionals when required. The environment had been improved and there were ongoing plans for additional refurbishment later this year.

Recruitment procedures had been followed and the relevant information obtained to help ensure that people were protected. There was an increased number of staff on duty to meet people's needs and help them to access community services more often.

When we visited the service 29 people were accommodated. We spoke to three people living in the home, four relatives who were visiting, three care staff, the deputy manager, the activity co-ordinator and the registered manager. We looked at the environment and spoke to additional people briefly around the home. People told us, "I like it here very much, I can do what I like", "the staff are kind to me" and "the staff are alright and the food is good". The relatives were able to tell they would recommend the home and they told us, "they treat mum with respect" and "the staff are lovely with her (mother)".

The environment required some refurbishment, which the provider was planning to complete soon. We found that there were times when the home was short of staff to meet people's needs and the manager agreed that improvements would be made.

Any concerns or complaints people or relatives raised had been taken seriously and handled appropriately by the staff.

People told us that they were respected and treated with dignity.

We spoke with several people that told us, "the staff are so good they look after me", "I like company and there is always plenty to do", "the staff are very friendly" and "I have agreed my care plan".

We observed staff supporting people to help maintain their independence in a friendly and respectful manner.

People told us they had completed surveys about the home. A relative told us they had attended two resident and family meetings where concerns could be raised and new ideas for the home were talked about. People and their relatives told us that any concerns raised were always responded to.

Keychange Sceats offer accommodation to 30 older people and people living with dementia who require personal care. This inspection was conducted unannounced on the 15 and 19 June 2015.

A registered manager was in post and was registered by the Care Quality Commission (CQC) in 2015. A registered manager is a person who has registered with the CQC to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People were not protected from unsafe use of medicines. Members of staff were not accurately recording medicines administered to people.  Protocols which instructed staff on administering when required medicines were not in place for people. This meant staff did not have the information they needed to make a decision about when to administer the medicines.

People were not protected from the spread of infection. We saw areas of the home were dirty and in need of repair. Faulty equipment was not repaired promptly which meant people’s access was restricted.

Staff had a good understanding of risk management systems. Risks were assessed and action taken to reduce the level of risk. Where people experienced repeated falls there was an investigation on the cause of the accidents and action taken to reduce them.

People told us there were people who became aggressive towards them, the staff and other people. We saw staff recorded the nature of the behaviours some people exhibited when they became frustrated and anxious to establish the behaviour communicated. However, a plan of action on how to respond to these behaviours was not in place. It was also noted that safeguarding referrals were not made to the lead local authority for safeguarding when people showed physical aggression towards each other.

People told us they felt safe and staff were clear on their responsibilities to protect people from abuse.

People and staff told us staffing levels were good and they received the attention they needed. Members of staff benefitted from training and support from their line manager to perform their roles and responsibilities.

People told us the staff enabled them to make decisions for example, they were shown the choices and given advise on the choices available. People’s capacity to make decisions was assessed and where they lacked capacity the completed Mental Capacity Act (MCA) assessments provided staff with the legal framework to make best interest decisions for people. Where there were restrictions on people’s cigarettes MCA assessments were not in place. This meant staff had not assessed if people’s impairment prevented them from understanding the consequences of their decisions.

Deprivation of Liberty Safeguards (DoLS) applications were made to the supervisory body for people who needed continuous supervision from staff.

People told us the food was good and staff told us they catered for people’s special diets. The range of fresh, frozen and tinned produce showed people had a varied diet.

People had a choice of two GP surgeries and routine visits were arranged weekly. Staff told us where people needed to see the GP more urgently visits were arranged as require

People’s mental capacity was assessed to determine the decision they were able to make. Where best interest decisions were made by staff Mental Capacity Assessments (MCA) were undertaken to provide the legal framework necessary to make these decisions.

People told us the staff were good and cared well for them. They said the staff knew how to meet their needs. We were told their privacy and dignity was respected. Staff gave us examples on how they respected people’s rights.

End of Life pathways were being developed to improve the care staff delivered to people on their end of life journey.

People told us the staff knew how they liked their care and treatment delivered but few knew they had a care plan or had read them. Care plans in place were not developed on people’s assessed needs or from information and advice given by social and healthcare professionals. Members of staff said they had the information needed to provide the care and treatment needed by people.

People experienced meaningful activities and had opportunities to learn new skills. People were able to participate in group and one to one activities. People’s art and their crafts were on display throughout the home. The activities coordinator said people’s art on display kept them connected with their surroundings.

People told us they felt confident to complain and by the actions taken by the staff to resolve their complaints.

People and staff said the registered manager was approachable. The staff said the culture and team spirit was improving. Audits in place had taken place and action for improvements had been identified. Visits from an area manager took place regularly to ensure the quality of service was maintained and where action was needed a plan was developed which they reviewed on subsequent visits.

We made recommendations for the service to seek advice and guidance from a reputable source, about the management of fluid intake for people at risk of malnutrition.

We found breaches 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 this report.