About the service: Pinglenook is a residential care home providing personal care and accommodation for up to 16 people, some of whom have dementia. There were 13 people living at the service at the time of our inspection.

People’s experience of using this service:

•Whilst people received their medicines in a safe way and as prescribed by their GP, the staff team did not always follow the providers process of dealing with refused medicines. The staff team were appropriately trained in the management of medicines and their competency was assessed.

•On the day of our visit, door wedges were used in some people’s bedrooms due to them not liking their door shut. We questioned this practice and were informed following our visit that this practice had ceased. The provider was in the process of obtaining automatic closers.

•There were on the whole, appropriate numbers of staff available to meet people’s needs though we recommended the provider re visit the deployment of staff to ensure suitable numbers were available to meet people’s ever-changing needs.

•People felt safe living at the service. They told us the staff team were kind and caring and this was observed during our visit. People were treated with dignity and respect and were involved in decisions about their care and support.

•Appropriate recruitment procedures had been followed and the staff team had received appropriate training, guidance and support. We recommended the provider re visited the dementia training offered to staff to ensure it was suitable and effective.

•People’s needs had been assessed and risks to people had been identified and managed. The staff team followed the providers infection control procedures and lessons were learned when things went wrong.

•People were supported to eat and drink well and support from relevant healthcare professionals was sought when required. People’s wishes at the end of their life had been sought and training had been provided to the staff team.

•The staff team worked in line with the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) ensuring people's human rights were protected.

•Concerns and complaints were appropriately handled and people had a say on how the service was run.

•People were provided with a clean and tidy place to live. People’s likes and dislikes were observed and activities of choice were offered.

•Monitoring systems had been introduced enabling the provider and the registered manager to effectively assess the service being provided.

More information is in the full report.

Rating at last inspection: Inadequate - last report published 17 September 2018.

Why we inspected: At the last inspection in June 2018 we found six breaches of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014.The service was rated overall Inadequate with an Inadequate rating in the Safe and Well led domains and a Requires Improvement rating in the Effective, Caring and Responsive domains. A warning notice was served and the service was placed in special measures.

Following our inspection, the provider informed us what they would do to meet the regulations.

We carried out this comprehensive inspection to check their progress against the warning notice served and to check if they had now met the regulations. Our visit was unannounced. This meant the staff and the provider did not know we would be visiting. During this inspection we found the provider had implemented the necessary improvements, though some areas still needed addressing. At this visit we found evidence to demonstrate and support the overall rating of Requires Improvement. The service is no longer in special measures.

Follow up: We will continue to monitor the home in line with our regulatory powers.

More information is in the detailed findings below.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place 11, 12 and 28 June 2018 and was unannounced. This was the provider’s first rated inspection since they bought the home in August 2018 and registered with us. We brought the inspection forward due to concerns we received from a whistle blower and the subsequent visit by the local authority, following our safeguarding referral about the concerns shared with us. The concerns we received were in relation to allegations of abuse, unsafe care, and poor facilities.

During the first two days of inspection we found a number of areas of concern. After these visits we liaised with the police and local authority who had undertaken their own investigations and checks on the service. Following this liaison we returned for a third visit on 28 June 2018 to check whether any of the necessary improvements had been made since our initial two visits.

Pinglenook Residential Home 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. The home provided care for a maximum of 16 older people. Thirteen people lived at the home at the time of our inspection. The home comprises of a communal lounge and dining area; and some bedrooms on the ground floor; with more bedrooms on the first floor along with the manager’s office. There is some outdoor space for people’s use at the rear of the home.

At the start of our inspection there was no 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. By the third visit a manager was in post although had not yet applied to be registered with the CQC.

People were not always safeguarded from harm. Safeguarding authorities had determined that some people in the home had been neglected and acts of omission had occurred.

People did not always receive timely referrals and reviews of their care when their needs changed. For example, peoples’ weights had not been monitored despite some people requiring nutritional supplements.

Accidents and incidents, such as falls, were not analysed and used to help identify how to reduce the likelihood and make improvements. Risks related to people’s care had not been updated since the registered manager left and staff had not always taken appropriate action to manage new and emerging risks.

Risks associated with the cleanliness of the premises were not effectively managed and dealt with appropriately. Some areas of the home had fallen into a state of disrepair as no monitoring had taken place or action taken in a timely manner.

Infection prevention and control practices did not protect people from the risks associated with infection.

The management of medicines did not follow best practice as set out by the Royal Pharmaceutical Society Guidance for Care Homes. Not all external creams or ointments had dates of opening recorded or body maps in place. Errors were not being identified or acted on when people missed their medicines that were due at set times.

Staff had not received all the training considered essential to provide safe and effective care. Management checks to determine whether staff were competent to carry out specific tasks had not taken place to assure them staff knew their responsibilities.

There were not enough staff employed or deployed to meet people’s needs in a timely manner, and to provide people with emotional support when they needed it. Following the concerns identified, the provider contacted an agency to provide staff cover, however, appropriate checks had not been completed by the provider to ensure they had the right skills and train