This unannounced inspection took place on 3 December 2018.

Lehmann House 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.

Lehmann House accommodates 34 people across three separate units on two floors. On the day of our inspection there were 11 people accommodated in two ground floor units. One unit specialising in dementia care and the other nursing care. Some people supported in the nursing unit were also living with dementia. The two first floor units were not being used.

At the last inspection in April 2018 we rated Lehmann House overall as Inadequate. This was because systems and processes were not in place to ensure that people received good quality of safe care. Following that inspection, we met with the provider and asked them to complete an action plan to show what they would do and by when to improve all of the key questions to at least good. We imposed conditions on the provider’s registration which required them to provide us with monthly updates regarding improvements. We also restricted new admissions to the service.

At this inspection we found that improvements had been made in all areas. Initial actions have been completed and further work is ongoing to embed the changes into the management of the service. The service will come out of special measures as it is no longer rated Inadequate overall.

Since our last inspection the service had worked closely with the local authority to improve the content and quality of care plans. Care plans now contained more detailed information with regard to the assessment of risk and people’s care needs. However, further improvement was still required to the management of risk in relation to specific conditions and the management of some other risks such as the management of pressure ulcers. Risks from the environment were now managed effectively, for example with regular fire drills.

Care plans were regularly reviewed with the involvement of people and their relatives, where appropriate, to ensure they were up to date.

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 were now recruited safely with the appropriate checks carried out before staff began work.

Meals were nutritious and varied. People told us they enjoyed the meals at the service and confirmed they were given choices. Where people needed support with their meal this was provided. However, we did observe one occasion where this could have been improved.

There were sufficient staff to provide the care and support people required. Staff now received appropriate training to meet people’s needs. Some improvement was needed in staff understanding of how to support people living with dementia.

People were treated with care and kindness. People's wellbeing was protected and all interactions observed between staff and people living at the service were respectful and friendly. People confirmed staff respected their privacy and dignity.

The service provided support for people to engage in activities. On the day of our inspection the activities manager was not at the service. We received mixed views from people about how they were supported to maintain their hobbies and interests. The manager has told us how they plan to improve this area.

People and relatives were aware of how to make a complaint. They told us they could approach

management and staff with any concerns and felt they would listen and take action.

Since our inspection in April 2018 the provider has made changes to the management structure in the service. This included the recruitment of a new manager who has applied to the Care Quality Commission to register and a compliance manager. The role of the

Lehmann House is a ‘care home’. 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. Lehmann House provides nursing care.

Lehmann House is located in the Suffolk village of Wickham Market and accommodates up to 34 people. There were 14 people accommodated at the time of our inspection.

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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

This was the first inspection of Lehmann House since the new provider; De Vere Care Ltd took over Lehmann House and registered it in October 2017.

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.

There had been a lack of oversight of the service by the provider, poor management and leadership with no clinical governance, which had led to people’s safety and welfare being compromised.

Provider governance systems were not operated effectively in order for them to provide an accurate overview of the service and ensure proper monitoring and review, identify shortfalls and inform an ongoing plan for improvement. The provider’s systems had failed to identify the issues we found during our inspection.

Thorough risk assessments were not carried out routinely to identify and mitigate risks in relation to people's healthcare and support needs, and fire safety. Necessary health and safety precautions had not been taken within the home to protect people from harm.

An effective system was not in place to ensure there were sufficient numbers of staff on duty to support people and meet their individual care needs. There were not sufficient numbers of skilled, trained and experienced staff to meet people’s needs effectively at all times.

The culture within the home did not promote a holistic approach to people's care to ensure their physical, mental and emotional needs were being met. Audit and monitoring systems had either not been sustained or were ineffective to ensure that the quality of care was consistently assessed, monitored and improved.

People’s care was not co-ordinated or managed to ensure their specific needs were being met. Records were incomplete and not reviewed. Where people were found to have significant weight loss this was not identified, managed promptly and effectively.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible.

Care records did not provide enough information for staff around safe care and supporting people’s wellbeing. Improvements were needed in staff’s understanding of dementia care to enable them to support people in providing care that was effective and person centred. This included staff’s knowledge in managing high levels of anxiety and supporting people to have access to meaningful stimulus, tailored to their level of dementia/needs.

Training for staff was not managed effectively. The majority of the care staff employed had not worked in care before. The provider had not made arrangements to support staff through training and supervision. Recruitment practices were insufficient and did not fully explore people's background. New staff where not supported in their role.

Given the level and seriousness of our concerns following this inspection we shared the information we had with the local authority safeguarding and contracts team. We sent an urgent action letter to the provider telling them about our findings