This inspection took place on 7 and 8 August 2018 and was unannounced.

Pondsmead Care Home was last inspected in July 2017 and was rated requires improvement. We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009.

At the last inspection we found there were insufficient staff to meet people’s needs in a safe and timely manner. We also found that following an independent review of fire precautions some work needed to bring the fire precautions to the recommended standard had been completed. However, there remained areas, including one which had been identified by the review as "significant", which had not been completed. We also found records had not always been completed accurately to reflect how and when care had been provided to people in the home. The systems in place to monitor the quality of the service provided had not identified the shortfalls found in the inspection. The provider sent us an action plan setting out how and when they would be compliant.

At this inspection we found there had been an improvement in all areas of care and support provided in the home. However, there was still work needed to maintain the improvements consistently. We found that there was an inconsistency with the recording in care plans between the residential unit and the nursing unit. The residential unit care plans were person centred with sufficient guidance for staff to follow. However, the care plans on the nursing unit were more generalised and less person centred. Staff on the nursing unit had failed to record interventions in the correct forms. These shortfalls had been identified by the registered manager and training and one to one supervision had been put into place. This meant the systems in place to identify shortfalls and drive improvement were more robust and had been used effectively.

There were sufficient staff to support people in a safe and timely manner a reorganisation of the home so that people with non-nursing needs were cared for on one floor meant staff were deployed more effectively. Staff spoken to said they had more time to spend with people and less “running up and down stairs.”

The first day of the inspection was carried out by one adult social care inspector, a specialist nurse advisor (this is a person who provides specialist advise during the inspection on general nursing) and an expert by experience and was unannounced. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service. The second day was carried out by one adult social care inspector and a specialist nurse advisor and two assistant inspectors and was announced.

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

All the work required to bring the fire precautions up to the recommended standard had been completed and fire precautions in place in the home were found to be safe.

The administration of medicines was managed safely however it was noted that one person’s pain management care plans had not been developed following their initial assessment. The registered manager had identified that staff were recording pain management in daily records and not the specific form. training had been arranged for all staff in the correct way to use the electronic system.

People said the standard of food in the home was good, one relative said they were happy to see their loved one eating a healthy well-balanced diet. There were choices available on a seasonal menu and people could request an alternative if they did not like the food on the menu for the day. The dining experience for people was relaxed and a social occasion. However, we saw the dini

This inspection took place on the 26 July & 01 August 2017. The first day of the inspection was unannounced. At the last inspection in March 2016 the service was rated Requires Improvement. All of the domains were rated Requires Improvement and there were two breaches of the Health and Social Care Act 2008. One related to mental capacity assessments and best interests decisions and the second related to care planning. We looked at these areas of practice as part of this inspection.

Pondsmead Nursing Home provides accommodation and personal care for up to 76 older people. At the time of our inspection there were 48 people living in the home of whom 23 needed nursing care. The home is arranged over three floors each floor having a communal living room and dining area. On the ground floor there is a recently refurbished dining room which is also occasionally used for activities. There are extensive grounds and garden with access from the dining area and lower ground floor.

There is a registered manager for this service. 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.

Records had not always been completed accurately to reflect how and when care had been provided to people in the home.

People told us there was not sufficient staff to respond to their needs in a safe and timely manner. Since the inspection the provider told us they had increased the care staff numbers on both morning and afternoon shifts. We have made a recommendation about staffing arrangements.

There had been an independent review of the fire precautions. The provider had put in place an action plan to address areas for improvement to ensure the fire prevention arrangements were safe and adequate. Whilst some of the work needed to bring the fire precautions to the recommended standard had been completed there remained areas, including one which had been identified by the review as "significant", which had not been identified in the action plan or completed.

People were confident about staff having the necessary skills however there were some staff who had not completed refresher or updating training in line with the provider's policy. We have made a recommendation related to staff training.

Whilst a system of quality monitoring was in place this had not always been effective in identifying shortfalls and ensuring improvements had been made in how the quality of service was maintained.

People told us they felt safe living at Pondsmead Nursing Home and staff understood their responsibilities in reporting any concerns about the welfare of people. As part of the recruitment process all potential employees were vetted to ensure they were fit to work with vulnerable people.

The arrangements for managing and administering medicines were safe and protected the health and wellbeing of people. However, there needed to be improved arrangements where people were administering their own medicines.

People had mixed feeling about the meals provided in the home. Some said there was not enough variety whilst others were satisfied with the menu and meals. Changes had been made to the menu and a questionnaire given to people had resulted in some positive comments and noted improvements. However it was recognised continued improvements needed to be made.

People described staff as caring and kind. One person told us that being caring "Was a strength" of staff. Another said, "They treat me with respect and are so caring. They always ask if I am ok just thinking about me." Staff were observed supporting people in a caring and sensitive way.

There was a range of activities available and people spoke positively of the activities. However, there were difficulties in ensuring everyone was su

This unannounced inspection took place on 10 and 15 March 2016. The last inspection of this service was in May 2015. Since the last inspection the service has been purchased by a new provider Pondsmead (Shepton Mallett) Limited and is now being managed by Avon Care Homes Limited on behalf of the owners.The care home is registered to provide accommodation, nursing and personal care for up to 76 people. The home is a large property with accommodation over three floors situated in the village of Oakhill on the outskirts of Shepton Mallett. At the time of our inspection there were 36 people living in the home.

At the time of our inspection there was no 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. The regional manager of Avon Care Homes was acting as manager of the home and was present throughout our inspection.

Improvements were needed in the management and administration of topical (eye ointments and skin creams) medicines. There were no arrangements to monitor they were being used correctly and as prescribed. Safe systems were in place for the administering and management of other prescribed medicines including those which required additional security.

We looked at arrangements for the use of equipment such as bed rails and pressure mats. These are used for the monitoring of people’s movements and can be viewed as restrictive. There was no evidence that the decision for use of this equipment had been made with the consent of the person or where a person lacked capacity a best interest decision had been made.

There was a failure to ensure records were consistent in identifying people’s care needs and completing assessments and care planning. There was differing information about people’s ability to make decisions. In one instance an assessment had been completed which indicated a high risk of skin breakdown but no care plan had been put in place to address this risk.

Staff demonstrated a knowledge and understanding of adult abuse and their responsibility to protect people from harm. They told us how they would report any concerns about possible abuse and were aware of their right to report any concerns to an outside organisations such as social services or the police.People told us they felt safe living in the home because they trusted staff. One person told us “I feel safe here because staff are here to care for us and they do.”

People told us how staff responded promptly when they used the call bell to request help. One person told us “The staff are there when you need them.” However people and relatives told us staff were not always available to “Just sit and have a chat.” This was something people told us they would have liked to happen more frequently.

Staff demonstrated an understanding of the importance of involving people in making decisions about their daily lives and those which affected their health and welfare. This was confirmed by people who told us “Staff always ask me what I want to do and where I want to be. It is my choice.” Another person said “What I do is up to me and staff always make sure it is my choice what I do.”

At our previous inspection there was a lack of training for staff. Staff told us training had improved and this was confirmed by training records. There was an ongoing training programme in place as well as a “learning topic of the month.”

People had access to healthcare services such as podiatrist and nutritionist. This also included more specialist support such as speech and language therapist. One person told us “If I want to see the doctor I just tell staff and they arrange it no questions.”

People told us they enjoyed the meals though some said they would have liked