We carried out this inspection on the 2 and 7 February 2017, the first day was unannounced.

Morven House is registered to provide residential care for up to 40 older people who are living with dementia. Some people use the service for respite care breaks. Accommodation is arranged over three floors and there is passenger lift access. There were 22 people using the service at the time of our inspection.

At our comprehensive inspection in February 2015, we found the provider was not meeting a number of regulations. We therefore asked the provider to take action in relation to staff training and support, providing safe care for people at risk of pressure ulcers, person centred care and good governance. Following the inspection, the provider sent us an action plan which set out the action they were taking to meet the regulations. At our next inspection in November 2015 we found improvements although we identified a continued breach in relation to good governance and a new breach in respect of medicines management. We also asked the provider to review people’s mental capacity assessments as they did not fully meet the principles of the Mental Capacity Act. We took enforcement action and issued a warning notice for the continued breach. When we checked for compliance with this notice on 12 July 2016, the provider had taken the required action.

The aim of this inspection was to carry out a comprehensive review of the service and to follow-up on the requirement action made in relation to the management of medicines. At this inspection we found the provider had followed their action plan and improvements had been made.

The manager in post at the time of our previous inspection left employment shortly afterwards and a new manager was appointed in November 2016. The new manager had begun the process of applying for registration. 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.

Improved arrangements were in place for the recording, safe keeping and administration of medicines. New audit systems had been introduced and regular checks were being carried out. People received their medicines as prescribed and when needed.

At this inspection we found improvements in care planning. Care plans were up to date and reflected people’s needs. Individual health, care and support needs were assessed and reviewed in a timely manner. Referrals were made to other professionals as necessary to help keep people safe and well.

People felt safe and the staff took action to assess and minimise risks to people’s health and well-being. Staff knew how to recognise and report any concerns they had about people’s care and welfare and how to protect them from abuse. The service responded appropriately to allegations or suspicions of abuse.

People’s rights were protected because staff were aware of their responsibilities under the Mental Capacity Act 2005. The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them. Conditions on authorisations to deprive a person of their liberty were being met.

Appropriate recruitment checks were followed to make sure staff were suitable to work at the home. Staff received an induction and essential training at the beginning of their employment. This was followed by ongoing refresher training to update and develop their knowledge and skills.

At the time of our inspection there were enough staff to meet people’s needs and keep them safe. Management were aware that staffing level

We visited Morven House on 12 July 2016. The inspection was unannounced.

Morven House provides residential care for a maximum of 20 people who may be living with dementia.

The service had recruited a new manager who was in the process of registering with CQC. 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 our previous inspections in February and November 2015 we found the service was not well-led because the provider did not effectively assess and monitor services provided to people to identify where improvements were needed. We found existing audit systems were ineffective and inaccurate.

At this inspection, we found the service had made improvements through the introduction of a wide ranging system of checks, reviews and audits to improve service provision. We will be carrying out a further inspection to address other breaches and concerns identified in our previous inspection in November 2015.

Communication with many of the people who live in this home is difficult, due to their dementia. However, all of them appeared to be happy and were interacting well with the staff that were caring for them. Those who were able to talk with us said that they were quite comfortable and that staff were very kind to them. They told us that they felt quite safe living in the home and if they had any worries they would tell the staff who would sort them out.

They told us that they were able to choose how they spent their time and that there were some activities arranged for them if they wanted, they seemed to particularly enjoy the “baking days”.

A relative that was visiting confirmed that staff were always very helpful, and that they were always informed if there were any issues. They told us that they did not have any concerns about the way that people were treated by the staff and were very happy with the placement.

People agreed that the meals in the home were good and we were able to see that for those who required help with feeding or prompting with personal care needs it was given sensitively and discretely.

The inspection of Morven House took place took on 25 and 26 November 2015. The inspection was unannounced.

At the previous inspection in February 2015 the service was not meeting the Regulations we inspected in the following areas: pressure ulcer management; appropriate training and support for staff; systems to actively seek the views and experiences of people using the service; and, effectively assessing, monitoring and improving services provided. We asked the service to provide an action plan outlining how they would improve to meet the Regulations. During this inspection we found the service had made improvements in all but one of these areas: effectively assessing, monitoring and improving services provided. We also found the service was not managing medicines safely and appropriately.

Morven House provides residential care for a maximum of 20 people who may be living with dementia. At this inspection 17 people were using the service. The service 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.

The service did not always manage medicines safely and appropriately. You can see what action we told the provider to take at the back of the full version of the report. However, we did see some good practice in relation to medicines management. Staff knew how to recognise and respond to abuse. They knew how to report safeguarding incidents, escalate concerns and were aware of whistleblowing procedures. People’s needs were assessed and risk assessments created. Risks were reviewed in response to changes in people’s needs but were not subject to regular, periodic reviews. There were sufficient numbers of staff to meet people’s needs.

Mental capacity assessments had been completed to identify each person’s capacity to make decisions and consent to care and treatment. These assessments did not address fluctuating capacity. Staff had the skills, knowledge and experience to deliver safe care and treatment. They were supported with appropriate training and supervision to provide safe and appropriate care. People were supported to have a healthy diet and to maintain good health.

People using the service and relatives commented positively about staff. We saw staff were kind and respectful and had time for people. People and their representatives were involved in making decisions about their care and treatment. Staff respected people’s privacy and dignity. People’s wishes around end of life care and cardio-pulmonary resuscitation had been discussed and put into place.

People received personalised care. Care records were person centred and addressed social and healthcare needs. People were involved in the development of their care and treatment. There were systems to actively seek the views and experiences of people and their representatives about their care and treatment. There were activities to stimulate people. People and relatives were confident they could raise issues and concerns with the staff and manager.

Although there were a number of audits to assess and monitor service provision they were not always effective. Medicines audits did not identify errors in the management of medicines.  You can see what action we told the provider to take at the back of the full version of the report. Staff meetings were held to pass on information and gather feedback.