This inspection was unannounced and took place on 30 and 31 October 2018. At our last inspection in March 2018 Laverstock Care Centre was rated as ‘Inadequate’ in all key questions due to concerns about the safety and well-being of people who lived there. We found seven breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Due to these concerns the service was placed in ‘Special measures’ by CQC. Services that are placed in ‘Special measures’ are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe.

Following the last inspection, we met with the provider to confirm what they would do and by when to improve the service. We also asked them to provide us with a weekly action plan to keep us updated with the action they were taking. At this inspection we found significant improvements had been made. This service is no longer in ‘Special measures’, however, the rating reflects that further improvement is required.

Laverstock Care Centre 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. Accommodation is provided over three floors for up to 80 people. Each floor had two separated units. Each unit had a separate lounge and dining room which included a small kitchenette. All rooms had en-suite facilities and there were communal bathrooms and toilets. At the time of our inspection 54 people were living at the home.

Following our previous inspection, the registered manager left the service. The provider appointed another manager who also left the service. A new manager was in post and in the process of registering with us. 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.

Risks had been identified but not all safety measures in place were robust. The provider had taken steps to reduce the risks we found at the last inspection. The environment was clean and cleaning schedules were being followed to maintain cleanliness.

People received their medicines as prescribed. Nursing staff administered medicines and had their competence assessed. Improvement were needed to how some medicines were stored.

Staff had been recruited safely as the provider had completed all necessary recruitment checks. Staff could identify the different types of abuse and knew how to report any concerns. There had been an improvement to the culture at the service so staff now felt more confident about reporting concerns.

Accidents and incidents were recorded and analysed by the clinical staff. Lessons had been learned and measures put into place to reduce the risks of reoccurrence.

People were being supported by staff who were trained. New staff received an induction and were allocated a mentor to support them with their learning. The provider had put key senior, experienced staff at the service to mentor and coach existing staff. This had improved staff confidence, skills and knowledge.

Where appropriate referrals to healthcare professionals had been made. Records demonstrated that people could access healthcare advice and support when needed. People received sufficient food and drink. Where people required additional monitoring of fluid this had been completed thoroughly.

People were being cared for by staff who were kind and caring. Overall people’s dignity was promoted and privacy respected. We observed interactions between people and staff that were caring and demonstrated that staff knew people and their needs well.

Incidents of distress were supported by staff

This inspection took place on 21, 23, 27 and 28 March 2018. The first day of the inspection was unannounced. This was the first inspection of the service, as there was a change in the provider’s legal entity in August 2017. Before the change, the service had a history of non-compliance with regulation. As a result of this, we issued a condition on the provider’s registration. This meant the provider was required to send us monthly reports regarding a range of audits such as staffing and the management of risk. The provider adhered to the condition although the information within the reports provided to us, was not fully accurate.

Laverstock Care Centre 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.

Laverstock Care Centre accommodates 80 people in one purpose built building. On the first day of the inspection, there were 69 people living at the home. People’s bedrooms were located over three floors. Each floor had two separated units. One unit supported people with nursing needs whilst the other supported those living with dementia. Each unit had a separate lounge and an adjacent dining room and kitchenette. Bedrooms had en-suite facilities and there were communal bathrooms and toilets. All units were supported by a central kitchen and laundry.

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. The registered manager was available during the inspection on all but the second day.

At this inspection, serious concerns were identified regarding people’s care. There were not enough staff to support people effectively and in a dignified way. There were periods during the early morning between 06.00 and 08.00 when units were not staffed. This was because the allocated member of staff was helping another member of the team, in a different unit. Insufficient staffing at this time meant two people did not receive assistance with their personal care. One person asked staff to help them to the toilet. Staff told the person to use their incontinence aid, as staff did not have time to assist them.

Potential risks to people’s safety had not been identified or properly addressed. In one person’s bedroom, there was a crash mat against the wall. This should have been on the floor to minimise injury, if the person fell from their bed. Re-positioning regimes to minimise people’s risk of pressure ulceration were not being accurately followed. People’s medicines were not safely managed and staff did not always follow safe moving and handling procedures.

People were not treated with dignity and respect and care was not person centred. The majority of interactions were task orientated and did not take into account people’s preferences. In one unit, people were assisted to bed without consultation. All except two people were in bed by 19.45. In the morning, there was an expectation a number of people would be “up and dressed” before the day staff came on duty at 08.00. Some people were “top dressed”. This was a practice where people were assisted to wash and dress the top half of their body. They were then able to return to sleep. One member of staff told us they started assisting people to get washed and dressed from 05.00 onwards. This showed routines were task orientated and for the benefit of staff, rather than people’s preferences.

We were not assured that people had enough to drink. Staff had identified those people at risk of dehydration. However, records showed some people had consistently not reached their recommended dail