The inspection took place on 3 and 7 April 2017. The first day of the inspection was unannounced and the second day was announced. We last inspected the home 15 and 24 February 2016 and found the registered provider met the regulations we inspected against.

Pavillion Care Centre provides nursing and residential care for up to 68 older people, some of whom were living with dementia. At the time of this inspection there were 56 people living at the home.

The home 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.

People said they received good care from kind, caring and considerate care workers. They also confirmed they were treated with dignity and respect. People, relatives and care workers also told us the home was safe.

Care workers knew how to report safeguarding and whistle blowing concerns. We found the provider had dealt with previous safeguarding concerns appropriately.

Where potential risks had been identified an assessment had been completed. The benefits of people taking risks and the measures needed to keep them safe were considered as part of the assessment.

We found there were sufficient care workers deployed to provide people’s care in a timely manner. People, relatives and care workers felt staffing levels were appropriate.

There were effective recruitment checks were in place to help ensure new care workers were suitable to be employed at the home.

Medicines were managed safely. Only trained nurses and senior care workers administered medicines. People confirmed they received their medicines at the correct time.

Accidents and incidents were logged and investigated with appropriate action taken to help keep people safe.

Health and safety checks were completed and procedures were in place to deal with emergency situations

Care workers received the support and training they required. Records confirmed training, supervisions and appraisals were up to date.

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.

People gave positive feedback about the meals they were served at the home. People received the support they needed with eating and drinking. Some people had been referred to external healthcare professionals for additional specialist support.

The home had been adapted to better suit the needs of people living with dementia.

People’s needs were assessed to enable personalised care plans to be developed. Care records contained a life history for each person and details of their preferences. Care plans were reviewed regularly to keep them up to date.

Activities were available for people to take part in, such as coffee mornings, a singing group, dominoes, skittles, pampering and a men’s club.

Regular residents’ meetings were held so that people could share their views and suggestions.

People did not raise any concerns about their care and knew how to complain. Previous complaints were investigated and resolved in line with the provider’s complaints policy.

People, relatives and care workers said the registered manager was approachable. The home had a homely and friendly.

A range of internal and external quality assurance audits were carried out to check on the quality of people’s care.

The inspection took place on 15 and 24 February 2016. The first day of the inspection was unannounced and the second day was announced. We last inspected the home on 14 December 2015 and found the registered provider met the regulations we inspected against.

Pavillion Care Centre provides nursing and residential care for up to 68 people. The home provides care and support for people, some of whom were living with dementia. At the time of this inspection there were 61 people living at Pavillion Care Centre.

The home 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.

People told us they received good care from kind and considerate staff. They went on to tell us they were treated with dignity and respect. One person commented, “[Staff were] very kind, very caring. They are a good set of lasses.” Another person said, “[Staff member] is lovely, she is a good lass. I like [staff member], she has a lovely personality.”

People, family members and staff told us the home was safe. One family member told us, “I know [my relative] is safe, they have one to one observations, there is always someone here.”

Staff showed a good understanding of safeguarding adults and whistle blowing, including how to report concerns. They said they felt concerns would be dealt with effectively. One staff member said, “[Registered manager] is a responsive manager, approachable. She would listen and do the right thing.”

Medicines records supported the safe administration of medicines. We found records were accurate and medicines were stored safely.

People said staff responded to their needs quickly. However family members gave mixed views about the appropriateness of staffing levels in the home.

Family members gave us good feedback about the home’s environment. One family member commented, “It’s a lovely large room with an en-suite toilet, and [my relative] has a lovely big window.” We found the home was clean and tidy.

Effective recruitment and selection procedures had been followed to check prospective new staff were suitable to care for vulnerable people. References had been received and Disclosure and Barring Service checks carried out.

The registered provider carried out regular health and safety checks, such as checks of fire safety, emergency lighting, gas safety and electrical safety. A specific plan had been developed to deal with emergency situations. Personal Emergency Evacuation Plans (PEEPs) had been written for each person using the service.

Staff were well supported and received the training they needed to care for people appropriately. One person said, “The staff are well trained, I can’t fault them, they just have too much paperwork.” One family member commented, “They all work together, the girls work well as a team.”

The registered provider followed the requirements of The Mental Capacity Act 2005 (MCA). Deprivation of Liberty Safeguards authorisations were in place for those people requiring authorisation. Staff supported people to make decisions in people’s ‘best interests'. People received care and support only when they had given consent.

Staff had a good understanding of how to support people with behaviours that challenged.

People received the support they needed from staff to ensure their nutritional needs were met. People gave us positive feedback about the meals provided in the home. One person said, “Meals are very good. You can have any amount, seconds if you like.”

People had regular access to a range of health care professionals including community nurses, dietitians, speech and language therapists and GPs.

Further improvements were required to the care and support of people living with dementi

We carried out an announced comprehensive inspection of this service on 27 May 2015, 2 June 2015 and 5 June 2015. A continuing breach of legal requirements was found because records and systems operated by the registered provider did not support the continuing safe management of medicines. We issued a warning notice requiring the registered provider to comply with regulation by 31 August 2015. The registered provider had also breached further legal requirements because it was not following the requirements of the Mental Capacity Act 2005 (MCA) where people were unable to consent to their care because they lacked the capacity to do so. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach of the regulations.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Pavillion Care Centre on our website at www.cqc.org.uk.

We found the quality of medicines records had improved. Medicines administration records (MARs) had been completed correctly with no gaps or omissions in the records. MARs were in line with people’s ‘blister packs’. A blister pack is a method used by some pharmacists to pack medicines in sealed compartments, ready to be administered by a third party.

A system of daily, weekly and monthly medicines audits were in place to check on the quality of medicines management. These had been effective in identifying issues with medicines and ensuring action was taken. The in-house quality development team had carried out a specific medicines audit in October 2015. The home received a quality score of 95% for compliance with medicines.

The registered provider had spent time with staff individually to assess their knowledge of the MCA. The required documentation was now in place to show decisions to deter people from leaving the home had been made in line with the MCA, including evidence that a decision had been made in people’s best interests. MCA assessments and best interest decisions had been made for a range of other decisions where people lacked the capacity to make their own decisions.

We spoke with ten people who use the service and six relatives who were very complimentary about the service provided. One person said, “I really like it here as I feel safe” and “my room is lovely”. Another person said, “I can only be positive about the home, the staff are great.” Another person told us, “This home has it all, good staff with a sense of humour, good care and very good food.”

One relative we spoke with said, “This is a nice home, very friendly with good staff and good care. I am content leaving my mum in here.” Another relative told us they were “happy” with the home.

We found people’s privacy, dignity and independence were respected and people experienced care, treatment and support that met their needs and protected their rights. We found medicines were safely handled and people were cared for by staff who were supported to deliver care and treatment safely. The provider had an effective system to regularly assess and monitor the quality of service that people receive.

Some people were not able to tell us directly what they though about the service. We decided to undertake a Short Observational Framework for Inspection (SOFI) exercise. SOFI is designed to be used when inspecting services for people who had some difficulty in communicating their opinions on the services they receive.

We spoke with relatives who told us they had the opportunity to visit and see the home for themselves before making their decision.

People told us they were “happy” at Pavilion Care Centre. They told us staff supported them appropriately with their healthcare needs. Comments from people relating to the care they received included, “The girls are lovely and they are always there for us”; “You can’t complain about the care here. It is excellent”; “Mom is well care for and we are grateful for the excellent care she gets here”.

People told us they liked their room and were happy with the home. People told us the staff kept them informed about the refurbishment work that was going and they felt safe and secure.

The service users spoke to us about their experiences at the Pavilion Care Centre. Those who spoke to us told us that they were involved in the management of their own care. They all said that the staff often spoke to them about their care plans and were told what was in it.

All the service users and relatives we spoke with were complimentary about the meals and described the cooking as “home made” meals. A visiting relative whom we spoke with also said that the food was always nice and well presented.

We spoke to a number of service users to find out how they felt about the care they received at the Pavillion Care Centre. The service users commented that they were well looked after by the staff. When we spoke to service users specifically about medication, they all said that they got their medication regularly and they had no problems in this respect

The service users told us that they felt safe in the home. One service user told us that the handyman was always available to do all the repairs in the home. Another service user told us that she was happy being in the home. She told us that the home was always clean and there was no odour on the ground floor where she lived.

The inspection took place on 27 May 2015, 2 June 2015 and 5 June 2015. Our visits on 27 May 2015 and 2 June 2015 were unannounced. Our visit on 5 June 2015 was announced. We found the registered provider had breached the regulations because they did not have accurate records to support and evidence the safe administration of medicines. We also found that a daily check on the accuracy of MARs had also not been completed consistently. During this inspection we found the registered provider had not made sufficient progress since our last inspection and was continuing to breach the regulations.

Pavillion Care Centre provides nursing and residential care for up to 68 people. The home provides care and support for people, some of whom were living with dementia. At the time of this inspection there were 57 people living at Pavillion Care Centre.

The home 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.

We found the registered provider had continued to breach Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because the provider did not have accurate records and effective audits systems to support and evidence the safe administration of medicines. We found medicines had been signed for as administered when they hadn’t been and some medicines were missing from people’s blister packs. Checks had been ineffective in identifying and dealing with these issues. We also found the registered provider had breached Regulation 11 because the registered provider did not always act in accordance with the requirements of the Mental Capacity Act (2005) where people lacked capacity to consent to their care. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe living at the home. One person said, “It’s just like being at home, but without the housework and cooking, I feel safe here.” We received mixed views about staffing levels. People and family members said: “I think they need more staff, we don’t get out on the bus as often as we should, it could be better”; “I think they all know what they are doing, but I think sometimes they are very short staffed”; and, “There seems to be a lot of agency staff.” Most staff said there were enough staff, although they were very rushed, “People are not left. It is a struggle but we get round everybody. One extra staff member would make a big difference.” The registered manager was making changes to how staff were deployed across the home. Most staff felt this would improve people’s care.

People using the service gave positive feedback about the care delivered at the home. One person said, “They look after you well here.” Another person said, “They don’t mind how much they do for you here, I like coming here.” We observed people received regular interaction from staff throughout the day.

We found the provider’s approach to risk management was inconsistent. We found specific risk assessments had not been undertaken where people lacking capacity were at risk due to attempting to leave the home unsupervised. Staff had a good understanding of safeguarding and whistle blowing. They knew how to report concerns and all staff told us they would not hesitate to report concerns.

The provider had recruitment and selection procedures in place to check new staff were suitable to care for and support vulnerable adults.

The registered provider carried out a range of health and safety checks to ensure people’s safety such as checks on the premises and equipment, checks on fire safety, window restrictors, specialist moving and handling equipment, electrical and gas safety. There were systems in place to respond to emergency situations. Each person using the service had a personal emergency evacuation plan which detailed their care and support needs in an emergency.

People were asked to give their consent before receiving any care and staff respected their decisions. Where people lacked capacity to make decisions a Deprivation of Liberty Safeguards (DoLS) application had been submitted to the local authority for approval.

Staff demonstrated a good understanding of the needs of people who displayed behaviours that challenged others. This included individual strategies to support people when they were anxious or distressed.

Staff were well supported and trained to carry out their caring role. One staff member said they were, “Fully supported. I can go to the nurse, clinical lead or manager. There is always somebody to turn to.”

People did not always experience a pleasant dining experience. People were sat waiting for a long time before their meal arrived. We saw that menus did not accurately reflect the meal choices available. People received the support they needed to ensure they had enough to eat and drink from kind and considerate staff. Meals offered to people looked appetising except for pureed meals. We have made a recommendation about this.

People were supported to meet their health care needs. They had access to health professionals when required, such as community nurses, dietitians and physiotherapists. We received positive feedback about the progress the home had made from a visiting community nurse.

Staff had a good understanding of the importance of maintaining people’s dignity and respect. People who wanted to were able to follow their religious beliefs.

Staff had access to detailed information about each person they cared for, such as their ‘life history’ and their care preferences. People had their needs assessed on admission into the home and this was used to develop care plans. Care plans we viewed were not always personalised and lacked sufficient detail to guide staff. Care plans had been reviewed regularly.

The registered manager was making changes to the activities programme so that people could access activities when they needed them most, such as at weekends and evenings. We observed the activities co-ordinator running a lively new initiative called ‘Oomph.’ We saw people were engaged with the activity and took part in singing and exercising. We have made a recommendation about this.

People and family members knew how to complain if they were unhappy. They told us they would be comfortable and confident going to the manager if they had a complaint. There were opportunities for people and family members to give their views about the care delivered at the home, such as regular meetings and questionnaires. The feedback from the most recent consultation was mostly positive.

We received positive feedback about the new registered manager from family members, staff and a visiting health professional. Staff told us the home had a good atmosphere. One staff member said, “Morale seems okay, I have not seen a sad face. The staff are friendly and approachable.” One family member commented, “Staff are all very approachable, they contact me at home if they have any issues with [my relative].”

The registered provider had systems in place to assess the quality of the care people received. Action was taken to follow some audits to address areas for concern. A senior manager external to the service and an external quality team undertook regular monthly audits. The registered provider was working towards completion of an action plan developed in March 2015 following a CCG clinical quality assessment audit.