The inspection took place on 26 and 31 October 2017 and the first day was unannounced. This meant the provider did not know we were coming.

Peel Moat is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Peel Moat provides accommodation for up to 31 people who require personal care, some of whom are living with dementia. At the time of the inspection, 28 people were living in the service.

At the last inspection undertaken on 1 August 2016, the registered provider had breached Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was in relation to the lack of risk assessments relating to the premises, risk assessments in relation to people at risk of choking, medicines management, staff training was not up to date and the registered provider’s quality assurance systems had not identified the areas of concern we found. We also made a recommendation because the home did not have features to support people living with dementia, such as reminiscence material, items of visual or tactile interest, or dementia-friendly signage. The overall rating for the service was requires improvement.

Following the last inspection we asked the provider to complete an improvement action plan to show what they would do and by when to improve the key questions, is the service safe, effective, responsive and well led to at least good. At this inspection, we found that improvements had been made in all areas and plans were in place to make further improvements.

The service had 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 registered manager was absent and the deputy manager was available throughout this inspection. We were informed that the registered manager left the service shortly after our inspection and plans were in place to recruit a suitable replacement.

We raised concerns during the first day of this inspection about the recruitment process for a new member of staff. There were also concerns about a person’s deteriorating health and behaviour which had resulted in an incident. The deputy manager took prompt action to address both matters.

We saw that improvements had been made to the management of medicines and risk assessments were now in place for the premises. This included a risk assessment for the new alarm system, which had been introduced following feedback from the Coroner in relation to an incident at another of the registered provider’s services.

Risk assessments were in place for people who had identified problems with swallowing which meant they were at risk of choking.

Staff training was not up to date. However, this was because there had been a number of staff who had recently come to work at the home who were undertaking induction training. We recommended that the outstanding staff training is completed as soon as possible.

We saw that the service had created a dementia friendly lounge, which had reminiscence materials such as visual items including 1950’s ornaments and furnishings. Further improvements had been made to the environment with ‘dementia friendly corridors’ to help people make their way around the home.

Staff we spoke with told us they would have no hesitation in reporting any poor practice they witnessed from colleagues and were confident they would be listened to by the deputy manager and action would be taken.

There were enough staff available to meet people’s needs.

People were supported to maintain their

The inspection took place on 1 August and was unannounced. This meant the provider did not know we were coming.

Peel Moat is a care home with accommodation for up to 31 people who require personal care, some of whom are living with dementia. At the time of the inspection 25 people were living in the service.

The service had 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 breached Regulations 9, 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

The service did not have features to support people living with dementia, such as reminiscence material, items of visual or tactile interest, or dementia-friendly signage.

We have made a recommendation that the service seek advice and guidance about the adaptation, design and decoration of the service.

We found some risk assessments for people who were at risk of choking were not reviewed. This meant we could not be sure those people’s care was appropriate or person-centred as their needs were not properly assessed.

We found that medicines were not being managed safely. Medicine records did not always give clear information for staff to follow. Some medicine administration records (MAR) showed gaps in recording. Temperatures for storing medicines were not always at a safe level.

We found the service did not have risk assessments relating to the building and work practices for staff to refer to.

The provider’s quality assurance process did not pick up shortfalls in medicine audits in relation to the safe storage of medicines. We found the audit document was not fully completed.

Staff training was not up to date. Staff told us and records showed they were not receiving regular supervision. The registered manager advised that only four staff members had received an appraisal in the last year.

People and relatives were complimentary about the service and made positive comments. They were happy with the care and support they received at Peel Moat. One person said, “I’m delighted with the care here. The girls are brilliant.” One relative said, “I’m happy because I know [family member] is safe and well looked after.”

Recruitment practices at the service were thorough and safe. The service obtained necessary checks before employing staff. For example, checks had been made with the disclosure and barring service (DBS) before new staff were employed. This was to confirm whether applicants had a criminal record and were barred from working with vulnerable people.

The registered manager used a dependency tool to ascertain safe staffing levels. They told us, “I also use common sense to increase staffing when activities are on.” There were enough staff employed to make sure people were supported. One person told us, “I have a buzzer, I press it and they come, they are pretty quick.” Another commented, “There is always staff about.”

Staff had an understanding of safeguarding and whistleblowing and told us they would speak to

management if they had any concerns. They felt confident that management would listen and act on any concerns they raised.

Systems were in place for recording and managing safeguarding concerns, accidents and incidents these identified trends or patterns. People and relatives told us they knew how to make a complaint. One person told us, “I would speak to the manager if I was not happy.” We found records to show complaints were responded to in a timely manner.

Staff understood the Mental Capacity Act 2005 (MCA) regarding people who lacked capacity to make a decision. They also understood the Deprivation of Liberty Safeguards (DoLS) to make sure people are not restricted unnecessarily.