We inspected OSJCT Townsend House on the 12 and 13 October 2017. OSJCT Townsend House provides accommodation, nursing and personal care to 40 older people and people living with dementia. It also provides short term respite for people, including people who require rehabilitation support. At the time of our visit 25 people were using the service. OSJCT is situated near the Centre of Mitcheldean, a town in the Forest of Dean. The home is located closely to a range of amenities. This was an unannounced inspection.

We last inspected the home on 1 and 2 September 2016. At the September 2016 inspection we rated the service as “Requires Improvement”. We found the provider was meeting all of the requirements of the regulations at that time; however we found that good practices had not always been established and maintained in relation to keeping the service clean and maintaining people’s care records. During this inspection we found the service was clean and people were protected from the risk of infection, however people’s care records were not always current or reflective of their needs.

A new manager had been in post at OSJCT Townsend House, for three weeks and they had intentions to register with the Care Quality Commission. 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.

While there was a new management team in place, there were not always effective and embedded systems in place to monitor assess and improve the quality of the service. Some quality assurances systems were not currently being used; however the manager and representative of the provider ensured us they planned to re-implement these systems.

People’s care records were not always current or reflective of their needs. Due to this people were placed at risk of receiving care which was not personalised to their needs. Additionally people’s capacity to consent to their care had not always been documented to show how people were supported to have maximum choice and control of their lives.

People enjoyed living at OSJCT Townsend House and told us they had active social lives and felt safe. People had access to activities and discussions from staff which were tailored to their individual needs and preferences. People felt cared for and happy. People and their relatives spoke positively about the recent management changes and the development of the home.

People were supported with their on-going healthcare needs. Care staff supported people to access the healthcare support they required. People told us they enjoyed the food they received within the home, and had access to all the food and fluids they needed. Where people needed support to meet their nutritional needs, these needs were met.

People were supported by staff who felt trained to meet their needs. The manager and provider were assessing and refreshing the training and competencies of all staff. Staff felt they had not always felt supported or had access to professional development, however they felt confident that the new manager was implementing plans to support their personal development.

We found two 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 this report.

This inspection took place on 1 and 2 September 2016 and was unannounced. Townsend House provides accommodation for 40 people who require personal care with nursing. There were 29 people were living in the home at the time of our inspection. The home provided personal care and support for people with residential and nursing needs.

Townsend House has a large lounge/dining room area and a variety of lounges and quiet areas to sit in. Most rooms and bedrooms are set on the ground floor with eight bedrooms upstairs which are accessible by a lift or stairs. The home has a hairdresser and offers a day centre service.

A registered manager was in place as required by their conditions of 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.

People told us they enjoyed living at Townsend House. Relatives were complimentary about the caring nature of staff. Staff approached people in a kind and caring manner. Staff ensured people received care and support in accordance to their preferences and needs. Their privacy and dignity were respected.

The home was generally clean however we found the cleanliness of some toilets and people’s equipment had not been maintained while the housekeeping staff were not on duty. We have made a recommendation about the arrangements to manage the cleanliness of the home.

People’s care and support needs were documented. People were supported by staff who respected their human rights and encouraged them to make decisions about their care. However, there were limited recorded assessments of people’s mental capacity where people could not make significant decisions about their care or agree to the care being provided. Plans were in place to update people’s care records to ensure they reflected their present needs. We have made a recommendation about how the service records and obtains people’s consent to their care.

People benefited from staff who understood and were confident about using the whistleblowing procedure. Staff were confident about recognising and reporting suspected allegations of abuse. There were safe systems in place to manage people’s medicines. People received their medicines on time by staff who were trained to carry out this role. People’s care records showed relevant health and social care professionals were involved with people’s care. Peoples nutritional and hydration needs were appropriately assessed and monitored. Specialist diets were catered for. Opportunities to take part in activities were available most days.

Staff told us they felt supported and well trained. Plans were in place to ensure that staff received regular support and address any shortfalls in their training. Staff felt the staffing levels to support people had improved. The registered manager was actively recruiting new staff. Safe recruitment practices where followed to ensure suitable staff were employed.

Quality monitoring systems were in place to check and address any shortfalls in the service. People and those important to them had opportunities to feedback their views about the home and quality of the service they received. Complaints were taken seriously and acted on.

People told us they were happy with their care and one person's representative said "I cannot fault them" (referring to the staff). Despite some gaps in record keeping we evidenced that people's needs were being met and their risks were being managed. People's wishes and preferences were being sought when planning their care and people were being treated with dignity. People confirmed that their permission and consent had been sought before decisions were made about their care or treatment. There were processes in place to ensure that people who lacked mental capacity were protected, although some staff had not received appropriate training on the subject. Staff had received training in safeguarding adult processes and there were policies and procedures in place for staff to reference. New staff, whilst waiting for this training, had been made aware of their responsibilities in relation to this. People knew how to make a complaint or raise a concern and these were listened to, investigated and responded to. The provider had made some improvements to how the service was staffed and a previously issued compliance action had been met at the time of this inspection.

People expressed their views and were involved in making decisions about their care and treatment. When asked about their involvement in planning their care one person said “They come up periodically and get me to read them. If I don’t agree I tell them”. The people we spoke with said “We are well looked after”. One person could not praise staff highly enough. Risk assessments had been completed and regularly reviewed in the records we checked. Care plans were in place to address risks in all but one incidence in the records we checked. People's medicines were managed safely within the home but the need for minor improvements was identified. Staff worked hard to make sure people's physical needs were met but we found that there were insufficient staff to meet people's social and emotional needs. Quality monitoring was carried out on a regular basis.

One adult social care inspector carried out this inspection over two days. We spoke with four people who use the service and inspected their care records. We spoke with two visitors about their relative's care and we spoke with the staff who delivered the care. We spoke with a company manager about the management of the service because at the time of this inspection the service did not have a registered manager. The focus of the inspection was to answer five key questions: is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and what the records told us.

If you want to see the evidence that supports our summary please read the full report.

Is the service safe?

The service was safe because it made sure there were enough staff on duty to ensure people's care needs were met. Where needed staff worked with other professionals to ensure people's physical and mental health health needs were also met. This included professionals such as the community nurse, the person's doctor, chiropodist and other specialists frequently visiting the service or communicating with the staff. People were safe because their care needs were assessed and care plans were devised. This meant staff were given guidance on how to meet people's needs safely. Robust policies and good staff awareness on subjects such as how to protect people from abuse and the Mental Capacity Act 2005 helped to ensure people's safety. People were further protected and kept safe through the use of robust staff recruitment practices.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Consideration of Deprivation of Liberty principles was reflected in people’s care plans. Relevant staff had been trained to understand when an application should be made and how to submit one.

Is the service effective?

The service was effective because it made sure there were suitably qualified and experienced staff on duty to meet people's needs. If needed they ensured this happened by filling gaps in staff availability with agency nurses. Staff could be effective because there was a good skill mix on duty at all times. The service was effective because it made sure that where people lacked mental capacity, decisions about their care/treatment were made by adhering to the Mental Capacity Act 2005. The service was effective in making sure people who were at nutritional risk were monitored and appropriate action was taken.

Is the service caring?

The service was caring because it supported people to make their own decisions and involved them in making adjustments to their care/treatment if necessary. It helped people remain independent where possible. One person said, "If it had not been for the staff here I would not be walking now." This person also said "they (the staff) were patient". Another person said, "Oh, they're marvellous here, they look after me well."

We observed staff knocking on people's doors before entering their bedrooms. This showed that people's personal spaces were respected as well as their right to privacy. The service was caring because staff had taken time to find out people's specific preferences and wishes and these had been incorporated into their care. We observed people being shown respect in the way they were spoken to. Two people told us that some staff were better at doing this than others but it did not upset them.

One visitor told us about how they had found their relative once. This had shown that, in one particular situation, staff had not shown care and had been disrespectful. The visitor had shown her displeasure to the staff and said they had not had a reoccurrence of the situation.

Is the service responsive?

The service was responsive because staff followed the care plans that were in place. This meant people received the care that they required and in a way they preferred. Where incidents or accidents had happened the service responded by making sure these had been managed correctly and looked for ways to avoid a reoccurrence. The service was responsive to people's individual risks and managed these. Complaints were acknowledged and resolved where possible.

Is the service well-led?

Despite there not being a registered manager in post the service was being led and it was being monitored. Arrangements had been put in place by the provider to ensure the service was safe during the absence of a manager. Risks to people's health and safety were being monitored and staff were being supervised. We observed staff following the lead of those who had the responsibility to manage the service on a daily basis. We observed senior staff advising and guiding staff on other matters as appropriate. The administrative staff were also providing visitors and staff with reassurances and guidance as needed.

There remained arrangements in place to receive people's views on their care/treatment and on other areas of the service being provided. A lack of one designated leader (a service manager) meant that some areas had not been fully followed through and resolved. An example of this was seen in the on-going issues relating to food. However, these were to be addressed following this inspection. Some of the processes that normally formed part of the arrangements for assessing and monitoring the service, such as certain audits, were on hold. However, key areas of risk such as infection control, care planning and risk management were being monitored and maintained at a safe level on a daily basis.

Arrangements were still in place to ensure staff were receiving their supervision sessions and the appraisal of new staff was taking place. The company's arrangements for staff training also remained in place with training having taken place and future training dates having been arranged. This meant staff were supported and their practices were monitored and updated.