This inspection was unannounced and took place on 15 May 2017. At our last inspection on 19 April 2016 we asked the provider to make improvements to several areas of their service. These covered medicine management, the meal experience, the stimulation on offer to people and the quality monitoring systems in place. The provider sent us an action plan explaining how and when the improvements would be made. At this inspection we saw that improvements had been made in all these areas of concern. We also asked the provider to make improvements to ensure there were enough staff to meet people’s needs. At this inspection, although we found there was enough staff, some of the time people’s needs were not being responded to. We have asked the provider to reflect on this area and consider how they can support people’s needs in a responsive way.

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 provider determined the staffing levels on the number of people living in the home and the level of support they required, however this was based on physical needs and not always included peoples emotional needs. . Staff had received training in a range of areas to support their role and further training had been planned to enhance their learning. People who used the service were safe and staff understood their role in ensuring people were protected from abuse or poor practice.

The provider and registered manager understood their responsibilities when people lacked capacity. We saw best interest decisions and assessments had been completed in line with guidance. Where people were being restricted of their liberty in their best interests, the appropriate authorisations had been applied for.

Everyone we spoke with felt that there had been improvements to the home and these had enhanced people’s experience of care. We saw that people were responded to in a kind and friendly manner and staff respected their decisions. Risk assessments were in place to ensure people’s safety was maintained and people’s independence was encouraged.

Medicines were managed safely and in accordance with good practice. People received food and drink that met their nutritional needs and had been encouraged to make choices in future menus. Staff made referrals to healthcare professionals in a timely manner to maintain people’s health and wellbeing.

Staff were caring in their approach and they created a warm homely environment which people told us they liked and enjoyed. People felt confident they could raise any concerns with the provider and manager. There were processes in place for people to express their views and opinions about the home. The provider and registered manager had systems in place to monitor and improve the quality of the service.

This inspection was unannounced and took place on 19 April 2016. The service was registered to provide accommodation for up to 26 people. People who used the service had physical health needs and/or were living with dementia. At the time of our inspection 19 people were using the service.

At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was enough improvement to take the provider out of special measures. CQC is now considering the appropriate regulatory response to resolve the problems we found.

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 provider had developed some auditing processes; however they had not been used to reflect the wider needs of the quality of the service or in driving improvements. Support for the management staff had not been provided or checks completed to ensure that the training the staff had received was understood and implemented.

People had not been consulted on the service and encouraged to be part of any improvements to the service or their environment. Staffing levels had improved, but there were some areas of the day when there were not enough staff to respond to people’s needs. People’s dignity was not always considered. Daily activities were not always provided to support people’s interests or hobbies.

Staff understood what constituted abuse or poor practice. There were systems and processes in place to protect people from the risk of harm. Medicines were managed safely and in accordance with good practice. Risks to people’s health and wellbeing were assessed. Where risks had been identified the provider had taken action to remove or minimise the risks. Changes to people’s health were responded to by referring them to healthcare professionals in a timely manner.

Where people lacked capacity to make decisions for themselves, there was an assessment to consider what decisions had been made in the person’s best interest. Staff received training to meet the needs of people living in the home and this was ongoing. People received food and drink that met their nutritional needs and when identified any risks through the monitoring of their health needs they were referred to other healthcare professionals to maintain their health and wellbeing.

Staff were caring in their approach, and offered support with aspects of people’s needs. People told us the staff respected people’s privacy and they were encouraged to maintain relationships with family and friends. The care records provided details of people’s preferences to how they wished to receive their care and about their life.

Staff told us they felt supported and they received regular supervision, which enabled them to identified areas of development or support. People and relatives felt confident they could raise any concerns with the registered manager and that they would be addressed.

We found 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.

This inspection was unannounced and took place on 15 October 2015. The service was registered to provide accommodation for up to 26 people. People who used the service had physical health needs and/or were living with dementia. Some of the people required nursing support. At the time of our inspection 25 people were using the service.

The service did not have 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 provider had recruited a manager and they told us they were going to apply to register with us.

The service did not have sufficient staff to support the needs of the people at the home and to keep people safe. There was limited information in the care plans which meant people didn’t always receive their care in accordance with their needs as it had not been documented or communicated to the staff. Risk to people’s health and wellbeing were not consistently identified, managed and reviewed. This meant people’s needs were not always met and the staff did not have the time to consistently treat people with dignity and compassion.

There was a limited choice of food; however there was not always the support available to encourage people’s independence or to assist people with their meal. Records were not maintained and monitored to ensure people received the required amounts to maintain their food and drink requirements.

The provider had not followed their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) People had not received best interest assessments to ascertain if they are able to make their own decisions or if they required support. Deprivation of Liberty Safeguards (DoLS) assessment had not been requested from the local authority.

Some people required support from health professionals to maintain their health. However there were some incidents which had not been referred in a timely manner which may have prevented people receiving the support they required.

Staff had little time to interact with people due to the workload and staffing constraints. We observed some interactions which showed kindness and care.

The staff had not received appropriate training before they commence working in the care environment and ongoing training was not checked to ensure staff understood and felt competent to use the training to support the care they provided.

The care plans provided to support people’s individual care were not centred around the person’s needs and preferences. The service offered little stimulation to the people or the opportunity to engage in a chosen activity.

People felt able to complain, however the provider did not have a process for managing complaints.

The provider had not been notifying us of incidents in the home which had affected people’s welfare and their potential safety.

The provider did not have systems in place to audit, monitor or manage the care provided at the home. Staff didn’t always feel supported by the manager or provider. The home required repairs to be made to ensure the environment was comfortable and safe for care to be provided.

The overall rating for this service is ‘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 so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

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

We spoke with seven people who used the service and two relatives. Most people who were able to express their views told us they were satisfied with the care they received, and felt that their needs were being met. One relative told us ‘‘My family member seems happy living at Oliver House. The staff are very good and respond to her needs.’’ Another relative told us ‘‘The care is quite good and my family member usually looks nice.’’

Most people said that they liked the meals. Appropriate records were kept to ensure that people were offered a choice of foods, and received sufficient diet and fluids.

Essential communications and records were in place to ensure that people received appropriate care and treatment. Arrangements were also in place to ensure that people's medicines were handled properly.

A new manager was appointed at the end of January 2014. She had introduced various changes to ensure that the service was well managed. Further systems had been put in place to monitor the quality of the service and to manage risks relating to people's welfare and safety.

We spoke with four people who used the service, two relatives and a visitor.

People who were able to express their views said they were generally happy with the care they received. They also said that they liked the staff that supported them.

Two relatives told us they were generally satisfied with the care their family member received, and felt involved in decisions about their care and treatment.

There was more to do to occupy people’s day as appropriate social activities were being provided.

An extra carer was provided from the teatime and early evening period, as this was when people required more support.

Aspects of the recording of people’s medicines did not ensure that all medicines were managed appropriately, and that people received them at the times they needed them.

This inspection showed that there had been some improvements since our last visit in June 2013. However, effective communications and concise care records were not in place, to meet people’s individual needs and ensure their welfare and safety.

Effective systems were also not in place to monitor all aspects of the quality of the service, and to identify and manage all risks relating to people's welfare and safety. This did not ensure that the service was well managed.

We spoke with ten people who used the service and four relatives.

Some people had limited communication. People able to express their views said they were happy with the care they received, and felt that their needs were being met. They also said that they liked the staff that supported them.

Relatives told us they were generally happy with the care their family member received. One relative said ’the staff are excellent; they provide personal care and treat people with respect''. Another relative told us ’’the staff are lovely; they really care and can’t do enough for people''.

People generally experienced care and support that met their needs, although priority needs to be given to establishing appropriate social activities to meet their needs.

Comments regarding the food were mixed. People were supported to have sufficient to eat and drink but they were not always offered a suitable choice of food, which reflected their preferences and needs.

People's medicines were handled safely and they received them at the times they needed them, although aspects of the recording of medicines did not ensure they were managed appropriately.

Procedures were in place for managing complaints about the service. People said that they felt listened to, and able to raise concerns if they were unhappy with the service.

Effective systems were not in place to monitor the quality of the service to identify and manage all risks relating to people's welfare and safety.

We did not speak to people using the service on this visit.

At our visit of 18 December 2012, although the people we spoke to had limited verbal communication they were all able to indicate that they liked living at Oliver House.

During this visit we found the provider had put systems in place to minimise the risk to people’s safety. The provider had installed thermostatic valve controls on people’s bedroom sinks to regulate the hot water temperature. The provider had disabled the deadlocks on people’s bedroom doors.

We found care plans had been signed by the staff member completing them.

We spoke to three people who live at Oliver House. Although the people we spoke to had limited verbal communication they were all able to indicate that they liked living at Oliver House. We also spoke to two relatives and eight staff members.

We found people's privacy, dignity and independence were respected. Relatives of people who use the service told us they were fully involved in discussions about their needs and care of their family member.

We found there was a good level of communication and contact between staff and people using the service. Care and daily routines were centred around people's individual needs and preferences. A relative told us the “staff are impressive.” Although care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare, we found some important risk assessments had not been completed.

We found there were effective systems in place to reduce the risk and spread of infection.

We found that there were enough appropriately trained, skilled and experienced staff to meet people's needs. We saw that staff had received relevant training for their job. We found staff were supported in their work and were confident that they were able to provide the care required.

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained. We found the provider had clear and effective systems in place relating to record keeping.

People using the service told us they liked the staff. One person described staff as “very nice”.

One person said “it’s alright here” and another told us they were “comfortable”.

People told us that ‘we get looked after’ and said ‘staff are very good’.

A visiting professional told us that the care was ‘quite effective’ and described staff as ‘polite’ and ‘courteous’.

Another visiting professional described the care provided as ‘variable’.

People told us that the premises were clean and that they were satisfied with the way their bedrooms were maintained.

Staff told us that there was no ‘deep clean’ being done and another said ‘I do what I can in the time’. Some staff also said ‘I don’t feel I’m progressing in my job’.

People told us they were happy at the service and received the help they needed. They said they felt ‘cared for’.

Staff told us that there were times when there were insufficient staff to deal with individual needs.

Other professionals had highlighted issues regarding cleanliness and infection control and inadequate record keeping. One described the service as ‘grubby’.

This was an unannounced inspection carried out on the 11 and 16 March 2015.

Oliver House provides accommodation and nursing care for up to 26 people who have nursing and dementia care needs. The accommodation is provided on two floors which are accessible via a passenger lift. There were 21 people living at the service when we visited.

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.

At our last inspection in September 2014 the provider was not meeting the requirements of the law in relation to the care and welfare of people who use services, meeting people’s nutritional needs, supporting workers and assessing and monitoring the quality of service provision. Following that inspection the provider sent us an action plan to tell us the improvements they were going to make.

During this inspection we looked to see if these improvements had been made. We found that improvements had been made in relation to meeting people’s nutritional needs and supporting workers through the provision of relevant training. While the provider now met the requirements of the regulations improvements were still needed in relation to keeping people safe and monitoring the quality of the service.

People told us they felt safe living at Oliver House. People’s relatives and friends agreed. They told us they were happy their relative or friend was living there.

Staff had received training on how to keep people safe from harm. However, we found that not all staff were moving and handling people safely.

Risks to the people who used the service had been assessed. This was to make sure that so far as was possible, people were provided with safe care and support.

Checks had been carried out on new members of staff to make sure that they were suitable to work at the service and training had been provided so they had the knowledge and skills to meet people’s needs.

We found some issues around the management of medicines. Records had not always been completed and protocols for medicines prescribed to be given when required had not been completed.

People told us there were enough staff on duty and they didn’t have to wait long when they needed assistance. We observed the staff assisting people throughout our visit and we saw them providing care and support in a timely manner. We did note that staff spent the majority of their time carrying out care tasks, leaving little time for social interaction with people who used the service.

An assessment of people’s needs had been carried out prior to them moving into the service and from this, a plan of care had been developed. People told us staff knew what help they needed and they provided help in a kind and caring way. We saw this throughout our visit.

People’s nutritional and dietary requirements had been assessed and a nutritionally balanced diet was being provided. Staff recorded when they had provided people with food and fluids and the records seen showed people had been provided with the nourishment needed to keep them well.

People told us they had been involved in making day to day decisions about their care and support and staff understood their responsibilities with regard to gaining people’s consent. When a decision had been made in a person’s best interest it was not clear who had been involved in the making of that decision.

People who used the service and their relatives knew how to raise a concern. They told us they were confident that any concern regarding their care or welfare would be dealt with appropriately and to their satisfaction.

People told us they were encouraged to share their thoughts of the service through daily dialogue with the management team and the staff. Relatives and friends had also been asked their thoughts on the service through the use of surveys. This meant that people involved with the service had the opportunity to have their say on how it was run.

Some staff felt supported by the management team but others did not. Staff meetings had been held but we noted that these had not been held for some time. The registered manager acknowledged that regular staff meetings would provide more regular support to the staff working at the service.

Arrangements for monitoring the service were in place to check the quality of service provision but not all areas of the service were included within this.