We inspected this service on 11 September 2017. This was an unannounced inspection. At our previous visit on the 6 September 2016 improvements were needed where people lacked the capacity to make certain decisions for themselves, to demonstrate that their rights were being upheld. Improvements were needed to ensure medicines were always recorded in accordance with good practice. The systems used to assess and monitor the quality and safety of the service required improvement, to ensure shortfalls were consistently identified and to ensure people's care was kept under review and remained relevant. At this inspection, the required improvements had been made.

Nethermoor House provides residential care for up to 19 people some of whom may be living with dementia. At the time of our inspection there were 19 people using the service. 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.

There were sufficient staff available to support people. People were supported by staff that understood their care and support needs to enable support to be provided in a safe way. People were protected from the risk of harm because staff understood what constituted abuse or poor practice and systems were in place to protect people from the risk of harm. People were given their medicine as prescribed and medicines were managed safely. Checks on staff were undertaken before they started work to ensure they were suitable to support people.

People’s needs and preferences were met by staff that received training and supervision, to support and develop their skills. People were supported by staff to make their own decisions and staff gained their verbal consent before supporting them with any care tasks. Where people were unable to make decisions independently they were supported in their best interests and in accordance with the Mental Capacity Act. People received food and drink that met their nutritional needs and preferences and were referred to healthcare professionals to maintain their health and wellbeing.

People were supported by staff that were caring towards them and supported them to maintain their dignity and privacy. People were supported to maintain relationships that were important to them and participate in activities to enhance their well-being. People’s opinions were sought by the provider to drive improvement. The registered manager understood their responsibilities around registration with us. Staff felt listened to and supported. People knew how to complain and we saw when complaints were made they were addressed. Quality monitoring checks were undertaken to monitor the service and when needed action was taken to make improvements.

This inspection visit took place on 6 September 2016 and was unannounced. At the last inspection on 5 August 2015, the service was rated as Requires Improvement overall with specific concerns about supporting people who needed help with decision making and managing risks associated with their care, the way medicines were managed, and the systems the provider used to assess and monitor people’s care. The provider sent us an action plan on 21 December 2015 which stated how and when they would make improvements to meet the legal requirements. This inspection was undertaken to check they had completed the work which was necessary to improve people’s safety and care. At this inspection, we found that some improvements had been made but further action was still required.

Nethermoor House provides accommodation for up to 19 people who require nursing or personal care. At the time of our inspection, 17 people were using the service, some of whom were living with dementia. There was a registered manager 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 in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We had asked the provider to take action to ensure that they recognised the rights of people who did not have the capacity to make their own decisions and complied with the legal requirements in place to protect people. We found the provider had made improvements and applied for the appropriate legal authorisations when people were being restricted to the home’s environment in their best interests. However, further improvements were needed where people lacked the capacity to make certain decisions for themselves to demonstrate that their rights were being upheld.

We asked the provider to take action to ensure risks to people’s health and wellbeing were managed safely. We found improvements had been made and risks to people’s health and wellbeing were assessed and managed. People received their medicines and creams as needed but improvements were needed to ensure medicines were always recorded in accordance with good practice. Staff understood their responsibilities to protect people from the risk of abuse. People were supported and encouraged to eat and drink enough to maintain a healthy diet and were able to access the support of other health professionals to maintain their day to day health needs. People were encouraged to keep in contact with family and friends and visitors were able to visit without restriction.

We found improvements were still needed to the systems used to assess and monitor the quality and safety of the service, to ensure shortfalls were consistently identified to bring about the required changes. People felt able to raise concerns and complaints and were confident they would be responded to.

Staff had caring relationships with people and respected their privacy and dignity. Staff understood people’s individual needs and improvements had been made to ensure people were provided with personalised care. However, improvements were needed to ensure people’s care was kept under review and remained relevant. People were offered opportunities to take part in group social activities but the improvements were needed to ensure the provider supported people to follow their individual hobbies and interests.

There were sufficient staff to meet people’s needs. The provider followed recruitment procedures and provided staff with training and support to enable them to fulfil their role.

This inspection took place on 5 August 2015 and was unannounced. Nethermoor House provides residential care for up to 19 older people. There were 19 people using the service at the time of the inspection, some of whom were living with dementia.

The service had 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.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed. Risk assessments and care plans did not reflect people’s current support and care needs and people did not always receive their planned care. People were not always kept safe and their welfare and wellbeing was not consistently promoted.

Some people who used the service were unable to make certain decisions about their care. The registered manager and provider could not show us that under these circumstances the legal requirements of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) were being followed.

People told us they liked living at the home and were satisfied with the environment and staff and the staff were kind, caring and helpful. Staff had a good knowledge of people’s individual care needs but made assumptions on behalf of people in regard to choices and options.

People were not consistently supported with their personal preferences because of routines and institutional practices. People were at risk of not receiving their prescribed medication in the correct way.

People told us the staffing levels were adequate but additional staff would be beneficial to provide the care and support to people. Staff were provided with a range of training subjects; however some staff had difficulty with transferring the theory into practice.

People told us they enjoyed the food that was provided and they had sufficient to eat and drink each day. People had access to a range of health care professionals and were supported to attend appointments when required.

Social, leisure and recreational activities were arranged, people were not always offered the choice to participate or not in the entertainment.

People who used the service and their relatives told us the management were open, friendly and receptive. People knew that any complaints they had would be dealt with appropriately. Systems were in place to assess the quality and safety of the home, but at times there were delays in making changes and improvements.

You can see what action we told the provider to take at the back of the full version of the report.

We completed an inspection on 26 July 2013, where we found the provider was non-compliant with outcome 16: Assessing and monitoring the quality of service provision. We found that improvements were needed. We found that the provider did not have effective measures in place to regularly assess and monitor the quality of service that people received.

After the inspection, the provider sent us an action plan. This told us the action the provider would take and by what date.

At this inspection we checked whether required improvements had been made to the quality assurance system at the home.

During the inspection, we spoke with the registered manager and completed a tour of the premises.

We found that the provider was compliant and had appropriate arrangements in place in relation to assessing and monitoring the quality of service provision.

During our inspection we spoke with the registered manager and two staff members.

We spoke with four people who lived at the home. We also spoke with six relatives who were visiting the home.

People we spoke with told us that they were happy with the standard of care provided and were involved in giving feedback to the service.

One person living at the home told us: "I like the staff very much. They are very patient".

One relative told us: “It’s really good here, you can’t beat it. The food is excellent. We are very happy with the home”.

We found that the provider had a system in place to ensure appropriate infection control standards were met.

Staff told us they were supported to deliver care safely and to an appropriate standard.

We also looked at Outcome 16: Assessing and monitoring the quality of service provision. The home was found to be non-compliant at the last inspection in December 2012. We found that the provider did not have effective measures in place to regularly assess and monitor the quality of service that people received. On the basis of this inspection we have judged that the home had not taken sufficient measures to assess and monitor quality standards at the home.

During our inspection we spoke with the registered manager, staff, relatives and a visiting professional.

People we spoke with were positive about the service.

One person told us, “The staff are very nice here”.

Another person told us, “The staff are good. We get to go on outings and have entertainers come in”.

Staff we spoke with told us they had appropriate induction training to undertake their work competently and had a good level of support from the management team.

We looked at five key outcomes to establish whether people were involved and participated in the service they received; whether care was provided appropriately; whether the home could adequately ensure people’s safety; whether requirements relating to workers were effectively implemented and whether there was a system for ensuring ongoing quality assurance within the home.

Nethermoor House was compliant in four outcome areas.

We found that the provider was non compliant in outcome 16. We found that not all systems in place were effective in assessing and monitoring the quality of service provision.

In this report the name of one of the registered managers appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a registered manager on our register at the time of our inspection. We have asked the provider to submit a notification to cancel their registration.

We involve people who use services and family care workers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using social care services, we have called them experts by experience. Our experts by experience are people of all ages, with different impairments, from diverse cultural backgrounds who have used a wide range of services.

People were satisfied with the support they received. Comments included, “I don’t mind it here”, “It seems alright to me” and "staff are excellent".

People were having their health and personal care needs met and there was an opportunity for people to take part in some activities. People's independence was promoted. Some people helped with baking, washing up and with polishing.

People got on well with the staff and staff knew about the care people needed. We did see that currently the service was short staffed. Sometimes people needed to wait for care and the staff were focused on undertaking care tasks. They had little time to spend with people and to talk with them.