About the service: Lowmoor is a care home that provides personal and nursing care for up to 42 people. At the time of the inspection, the home was fully occupied with 42 people living there. The home is separated into three units. A mixed gender unit downstairs, and a specialist male and female unit upstairs. These two units are for people with living with dementia and complex needs.

People’s experience of using this service:

• There was limited oversight of incidents that had occurred at the service, this meant people may not have been protected from future harm.

• This was a recurrent issue from the last inspection and had resulted in unsafe care for people.

• Moving and handling was not managed safely and some staff training was expired in this area. Some trained staff had been dismissed due to poor moving and handling practice.

• Improvements were needed around Mental Capacity assessments and people’s meal time experience

• Since the last inspection, we have seen considerable improvements to the service. This included, safe recruitment processes, regular staff supervision, safe medicine management, the use of effective communication aids, a robust complaints procedure, and better engagement with people using the service. These improvements had positively impacted on people at the service. People told us that they felt the service had improved.

• There was a new registered manager in place and people spoke positively about them. In the absence of the registered manager, the provider had failed to improve other aspects of the service. This continued failure had resulted in repeated breaches of the law. It had impacted on peoples’ safety.

• While improvements have been made, this service requires further work to ensure safe practice is embedded. Some significant concerns over people’s safety had not been adequately addressed. More information is in the full report.

Rating at last inspection: At the last inspection, the service was rated ‘requires improvement’ (Published 14 September 2018).

Why we inspected: At our last inspection we found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 13, 17, 18 and 19. We inspected this service to see if improvements had been made as required.

Enforcement: At this inspection we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This included regulations 12, 13 and 17. We also found an ongoing breach of the Regulation 18 of the Care Quality Commission (Registration) Regulations 2009.

Information about CQC’s regulatory response to the more serious concerns found in inspections and appeals is added to reports after any representations and appeals have been concluded.

Follow up: We will continue to monitor the level of risk at the service until the next inspection visit.

The overall rating for this service is now ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement s

The inspection took place on 25 and 27 June 2018, and the first day was unannounced. Lowmoor Carehome 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. Nursing care is provided at this service.

Accommodation for up to 42 people is provided over two floors in three separate units. There were 41 people using the service at the time of our inspection. Lowmoor Carehome is designed to meet the needs of older people living with or without dementia.

This is the first time the service has been rated Requires Improvement.

The service did not have a registered manager at the time of our inspection visit. Lowmoor Carehome had not had a registered manager since 31 March 2017. 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 in December 2017, but the provider confirmed the manager had now left the service.

People were not consistently kept safe from the risk of abuse. The systems in place to identify and deal with concerns had not worked to safeguard people from abuse. The provider had not consistently ensured staff were of good character and were fit to carry out their work. Risks associated with the service environment had not always been assessed and mitigated. There was no comprehensive system to enable the provider to review accidents and incidents. People’s medicines were not always managed safely.

People were at risk from receiving care from staff whose skills and knowledge was not assessed or monitored. The provider had not consistently ensured that staff had undertaken training to enable them to meet people’s needs effectively. People and relatives were not consistently supported to participate in planning or reviewing their care. People who needed support to communicate were not always able to meaningfully participate in making decisions about their care.

Staff we spoke with were knowledgeable about people’s individual preferences and lifestyle choices, but this information was not consistently available to all staff. There was a risk people's views and information about their lives were not available to support staff in providing care. People and relatives knew how to raise concerns or make a complaint. However, concerns and complaints were not clearly resolved, and the provider did not have clear information about areas where improvements were needed. People experienced varying levels of support to maintain interests and hobbies.

The service was not well-led. There was a lack of consistent management at the service, which had affected people’s quality of care. The provider had not always notified CQC of significant events as they are legally required to do.

People and relatives spoke positively about the skills and knowledge of staff. There were enough staff to provide the care and support people needed. Risks associated with people’s health conditions were assessed and mitigated. Risks associated with infections were minimised, and the premises were clean. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink. People were supported by staff to access healthcare services when required. The provider had taken steps to ensure the environment was suitable for people's needs.

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. The provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had

This inspection took place on 2 and 3 August 2016 and was unannounced.

Accommodation for up to 42 people is provided in the service over two floors in three separate units. The service is designed to meet the needs of older people living with or without dementia. There were 42 people using the service at the time of our inspection.

A registered manager was in post and she was available during 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.

Staff knew how to keep people safe and understood their responsibilities to protect people from the risk of abuse. Risks were generally well managed so that people were protected from avoidable harm and not unnecessarily restricted.

Sufficient staff were on duty to meet people’s needs and staff were recruited through safe recruitment practices. Medicines were generally safely managed.

People’s rights were not fully protected under the Mental Capacity Act 2005. Not all staff had received sufficient training to support people with behaviours that might challenge.

Staff received appropriate induction, training and supervision. People received sufficient to eat and drink.

External professionals were involved in people’s care as appropriate. The environment had been adapted to support people living with dementia.

Staff were kind and knew people well. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People received care that respected their privacy and dignity and promoted their independence.

People received personalised care that was responsive to their needs. Care records contained information to support staff to meet people’s individual needs, though care plans could be further improved.

A complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident in raising any concerns with the registered manager and that appropriate action would be taken.

The provider and registered manager were generally meeting their regulatory responsibilities, however, they had not sent statutory notifications when DoLS had been authorised. There were effective systems in place to monitor and improve the quality of the service provided.

Due to the complex needs of the people using the service we used a number of different methods to help us understand their experiences when we undertook our visit.

Prior to our visit we reviewed all the information we had received from the provider. During the visit we spoke with three people who used the service and a relative and asked them for their views. We also spoke with four care staff, two nurses, the registered manager and the provider. We also looked at some of the records held in the service including the care files for six people. We observed the support people who used the service received from staff and carried out a brief tour of the building.

We found where people were able to they gave consent to their care and treatment and people received care and support that met their needs. A person told us, “I am treated reasonably well. I can make my own decisions, I am an independent person.” Another person told us, “I have the help I need to manage my mental health.

We found people who used the service were protected from abuse. A person told us, “They keep me safe here. They keep an eye on you. I see them watching to make sure others are safe.”

We found the staff team were supported through training. A person told us, “I think they are fairly well trained, I see them having meetings and training all the time.”

We found the provider had systems in place to deal with comments and complaints. A person told us, “If I have got any complaints I tell the manager. They then deal with it. I am happy how they deal with things. I am not made to feel bad for saying something.”

Lowmoor is a large care home divided into three units depending on the type of care people need. We saw care staff and people interact well and staff were attentive to people's needs.

One relative told us her father’s behaviour had improved since arriving in the home. Another relative told us that his mother’s dementia meant she could get quite agitated but that since arriving he thought she had settled down.

Care staff told us how much they enjoyed working there. Staff who had been there for several years told us that the assessment process had improved and as a consequence they were able to provide more personalised care and reduce challenging behaviour.

People told us they were happy living in the home and had no complaints.

A healthcare professional present on the day of inspection told us that she felt the home provided a supportive, professional environment. She said she had no concerns about the standards of care provided.

People who used services told us that they could express their views, so far as they were able to do so, and they were involved in making decisions about their care, treatment and support.

People who used services told us they had their health needs met and that they felt safe at the home.

A Relative told us they thought the home was “excellent”.

External professionals told us that people had their care planned properly.