The inspection took place on 3 September 2018 and was unannounced. The service was last inspected on 12 and 15 September 2017, where we found the provider to be in breach of the regulations in relation to safe care and treatment, premises and equipment, and good governance, and was rated Requires Improvement. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective and well-led to at least Good. At the inspection on 3 September 2018, we found that the provider had made some improvements but were not sufficient. This is the second time the service has been rated Requires Improvement.

Peregrine House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Peregrine House is registered to provide accommodation and personal care support to 36 people who have dementia, mental health, physical disability or sensory impairment support needs and older people. Peregrine House is a purpose built home divided into four units on two floors. Each unit has people’s bedrooms with toilet and sink facilities, a sitting area, a dining room and a kitchenette. At the time of inspection, 34 people were living at the home.

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 did not always follow appropriate infection control practices. Some communal rooms and people’s bedrooms were not appropriately cleaned. Staff knew safeguarding and whistleblowing procedures, and how to identify and report abuse. However, the management did not always follow appropriate safeguarding procedures. The provider had failed to notify us of a safeguarding concern as required by law.

People told us they felt safe living at the service. Risks to people were identified and assessed and measures put in place to mitigate those risks. Staff knew risks to people and how to provide safe care. There were suitable and sufficient staffing in place to meet people’s needs safely. People were provided with safe medicines management support. Accidents and incidents records were accurately kept with processes in place to learn lessons from them to prevent future occurrences.

People’s needs were assessed before they started living at the service and people told us staff met their needs. Staff told us they received regular supervision and training to provide effective care. People were generally happy with the food and the nutrition and hydration support. Staff supported people to access ongoing healthcare services to maintain healthier lives. Staff followed healthcare professionals’ recommendations to ensure people’s needs were met effectively. The provider was making progress with their premises refurbishment plans whilst causing least disruption to people living at the service. People told us staff gave them choices and asked permission before supporting them.

People told us staff were caring and kind. Staff were trained in dignity in care and respected people’s privacy. People’s cultural and religious needs were identified and recorded in their care plans. Staff supported and encouraged people to remain as independent as they could.

People were at the centre of the care planning process and relatives were involved where requested. People’s care plans were personalised and regularly reviewed. The provider promoted and encouraged lesbian, gay, bisexual and transgender people to use the service. Staff encouraged people to raise concerns and people wer

This inspection took place on 12 and 15 September 2017 and was unannounced. This service has not been inspected since its registration on 19 May 2017.

Peregrine House is a care home providing accommodation and personal care for up to 36 people who have dementia, mental health, physical disability or sensory impairment support needs and older people. Peregrine House is a purpose built home divided into four units on two floors. At the time of inspection, 36 people were living at the home.

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.

People and their relatives told us the service was safe and staff reliable. Risks associated to people’s health and care were identified and assessed, and instructions provided to staff on how to mitigate those risks. However, not all risk assessments had the most up-to-date information. Staff understood their role in safeguarding people against harm and abuse, and knew how to identify and report abuse.

People were supported safely with their medicines management and we did not find any gaps in medicines administration records. There were sufficient staffing levels and people’s needs were met. However, staff did not always work as a team and some staff felt stretched. The service followed appropriate recruitment procedures to ensure people were supported by staff who were suitably vetted before starting work.

The service did not meet appropriate infection control standards. There were some maintenance and repair issues that had not been fixed and posed safety concerns. The service was clean and did not have any malodour.

Staff received regular support and training to do their jobs effectively. Staff were aware of people’s needs and abilities and met those needs. The service operated within the legal framework of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

People’s nutrition and hydration needs were met and they liked the food. However, information on people’s nutrition and hydration intake was not always recorded and the assessments did not always correspond with the care plans. The service promptly involved health care professionals to improve people’s health and well-being.

People told us staff were caring and friendly and treated them with dignity and respect. Their cultural and spiritual needs were acknowledged and supported when required.

Staff recorded people’s likes and dislikes in their care plans and supported them to remain as independent as they could. People’s relatives were regularly informed about their family member’s health and updated on any changes. The provider responded appropriately to people and their relatives’ complaints. There were regular residents’ and relatives’ meetings where they could discuss their concerns and views.

The service did not always update people’s care plans to reflect changes in their needs. The service’s audits and monitoring checks did not always identify gaps and areas of improvement to ensure the quality and safety of the service delivery.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulation 2014. These breaches were in relation to safe care and treatment, premises and equipment, and governance.

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