About the service:

Poplars Nursing and Residential Care Home is a care home that was providing personal and nursing care to 44 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

The systems in place to monitor the quality of care were not effective and actions were not driving improvements. This was the third time the service had been inspected and had failed to achieve a good rating; people had been exposed to poor care for too long. The provider did not have robust strategies in place that enabled them to identify when staffing levels were not meeting people’s needs. Audit systems were in place but identified trends were not always acted upon. Regulatory requirements were understood and CQC notifications were submitted in accordance with the law.

People were not supported by sufficient numbers of suitable staff to meet their needs. People were not always supported to stay safe as staff did not always have time to follow people’s risk assessments. People’s medicine records were not consistently completed by staff. Systems were in place to safeguard people and staff understood how to protect people from abuse.

People’s needs and choices were assessed but staff did not always have the time to deliver support in line with people’s needs. Staff had the skills and knowledge to deliver effective care.

People’s dignity was not always respected. People were treated with kindness and compassion by staff. People’s privacy was respected and staff promoted people’s independence.

People were not always supported to follow their interests. People contributed towards the planning of care but personalised care was not always received. People’s concerns and complaints were encouraged and responded to.

The service met the characteristics of Inadequate in most areas. More information is in the full report.

Rating at last inspection: At the last focused inspection (report published 11 October 2018), the service was rated as Requires Improvement overall and Requires Improvement in the key questions of Safe and Well-Led. At the last comprehensive inspection (report published 28 April 2018), the service was rated as Requires Improvement overall with ratings of Requires Improvement in the key questions of Safe, Effective, Responsive and Well-Led. At the last two inspections, we asked the provider to make improvements.

Why we inspected: This was a planned inspection based on the rating at the last comprehensive inspection and to make sure improvements had been made.

Enforcement: Full information about CQC’s regulatory response to the more serious concerns found and appeals is added to report after any representations and appeals have been concluded.

Follow up: The overall rating for the service is inadequate and the service will be placed in special measures. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider's registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This

This inspection took place on 29 August 2018 and was unannounced. We carried out an unannounced comprehensive inspection of this service on 26 February 2018.The service was rated as requires improvements and there was a breach in Regulation because the provider had not ensured staff were deployed effectively to meet people’s needs.

After the inspection on 26 February 2018, we received concerns in relation to staffing levels, recruitment practices, risk management and governance systems. As a result, we undertook a focused inspection to consider those concerns. This report only covers our findings in relation to the concerns raised. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for The Poplars Nursing and Residential Care Home on our website at www.cqc.org.uk.

The Poplars Nursing and Residential Care 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 Poplars Nursing and Residential Care Home accommodates up to 60 people. At the time of our inspection 48 people were using the service. People were accommodated in one adapted building with support provided over three floors with five communal lounges for people to use.

There was a registered manager at the service who was present at the inspection. 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 were not safeguarded from harm because incidents of abuse had not always been identified and reported.

The registered manager had not always notified us (CQC) of incidents that had occurred at the service as required by law.

Improvements were needed in the way staff were deployed to ensure that people received the support they needed, when they needed it.

Improvements were needed to ensure the systems in place to monitor the service were effective in mitigating people's risks.

Medicines were administered and managed safely. People’s risks were planned and managed to keep people safe. Staff followed infection control procedures which meant people were protected from the risk of infection and cross contamination.

People, relatives and staff were able to approach the registered manager who was supportive and acted on feedback provided. The registered manager worked in partnership with other agencies to ensure consistent care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Poplars Nursing and Residential Care 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. Poplars Nursing and Residential Care Home is registered to accommodate 60 people. At the time of our inspection 48 people were using the service. People were accommodated in one building with support provided over three floors with five communal lounges for people to use. A courtyard garden area was also available that people could access.

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.

We inspected this service on 26 February 2018 and the inspection was unannounced. At our previous inspection in February 2016, the service received an overall rating of good. At this inspection we found that improvements were needed and the service was rated as requires improvement. This is the first time the service has been rated requires improvement.

There were systems in place to monitor the quality of the service but these were not effective in identifying all areas where improvements were needed.

Staff were not regularly available within most communal areas throughout the day to provide social stimulation and ensure they were available to people if needed. Improvements were needed to ensure people’s holistic needs were met by ensuring activities and opportunities for people to socialise were available on a daily basis.

People were not always supported to have maximum choice and control of their lives. Although staff understood the importance of gaining people’s verbal consent regarding the day to day support they received, some specific decisions had not been regularly reviewed. This did not ensure they remained consistent with the person’s wishes or remained in their best interests when the person was unable to make an independent decision.

There were processes in place for people to raise any complaints and express their views and opinions about the service provided but improvements were needed to ensure people knew how to raise concerns.

Recruitment checks were undertaken before staff commenced employment. People were protected against the risk of abuse, as staff understood their role to protect people from the risk of harm and their responsibilities to raise concerns. Individual risks to people and environmental risks were identified and minimised to maintain people’s safety.

Medicines were managed safely and people were supported as needed to take their medicine as prescribed. Assistive technology was in place to support people to keep safe. Systems were in place to prevent and control the risk of infection.

People were consulted regarding their preferences and interests and the staff team knew people well. People were supported by staff that were trained, and they were supported with their dietary needs and to access healthcare services to maintain good health.

People's rights to privacy and dignity were respected and they were supported to maintain relationships with people that were important to them. People’s representatives were involved the assessment and development of their care plans.

People who used the service and their relatives were involved in developing the service; which promoted an open and inclusive culture.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

This inspection took place on the 19 February 2016 and was unannounced. At our previous inspection on the 28 January and 2 February 2015 the service was meeting the regulations that we checked but we asked the provider to make some improvements to mental capacity assessments, the quality and variety of food and the activities available to people. At this inspection we saw that the required improvements had been made.

Poplars Nursing and Residential Care Home provides accommodation, nursing and personal care for up to 60 older people who may have dementia. There were 49 people living at the home at the time of our inspection.

There was a registered manager in post. The home is required to have 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 and associated Regulations about how the service is run.

People we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. Plans were in place to respond to emergencies to ensure people were supported appropriately.Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Checks were carried out prior to staff starting work to ensure their suitability to work with people and staffing levels were monitored to ensure people’s needs were met. Staff were knowledgeable about people’s care and support and understood what constituted abuse or poor practice and processes were in place to protect people from the risk of harm. People were supported to take their medicine as and when needed. Staff received training to meet the needs of people they supported and supervision, to support and develop their skills.

People received food and drink that met their nutritional needs and were referred to healthcare professionals to maintain their health and wellbeing. Where people lacked capacity in certain areas, capacity assessments had been completed to show how people were supported to make those decisions. When people were being unlawfully restricted this had been considered and Deprivation of Liberty Safeguards (DoLS) applications had been made to ensure people’s rights were protected. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions.

People were able to take part in social activities. People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us that the staff made them feel welcome and were approachable.

Staff listened to people’s views and they knew how to make a complaint or raise concerns. There were processes in place for people and their relatives to express their views and opinions about the service provided. People felt the service was well managed and they were asked to express their views and be involved in decisions related to the planning of their care. There were systems in place to monitor the quality of the service to enable the manager and provider to drive improvement.

In this report, the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Before the inspection we had received concerns that there was a lack of meal preferences for people using the service, there was a lack of social interaction, the home was short staffed and that staff were not wearing uniforms. The concerns also stated that people’s personal care needs were not being met effectively and that call bells were not always accessible to people. It was also stated that people were being injured due to poor moving and handling practices. Concerns had also been raised that when complaints were made some improvements were seen but these were not maintained.

On the day of our visit 57 people were using the service. Below is a summary of our findings based on our observations, speaking to people who used the service and visitors, the staff supporting them and from looking at records. We considered our inspection findings to answer the questions we always ask.

Is the service safe?

We did not see any evidence to suggest that people were at risk from poor moving and handling procedures. We observed staff supporting people using a hoist and this was carried out in a safe way. Information within accident and incident records did not indicate that injuries were caused by poor moving and handling practices.

The company policy was that staff did not wear uniforms. A staff dress code was in place to guide staff on suitable clothing. Visitors that we spoke with told us that they preferred staff to be in uniform so that they could be identified. However the majority of staff did wear name badges and personal protective equipment was provided to ensure infection control measures were maintained.

We saw from the staff rotas and from discussions with staff there had been a period of reduced staffing levels. The staffing rotas on the week of the inspection demonstrated that there were some days when the residential unit were short staffed. We were advised that staff from the nursing and dementia unit would be used to cover these shifts. However the rotas seen did not demonstrate this.

Is the service effective?

The training records showed that moving and handling training was provided on an annual basis and we saw that the majority of staff were up to date with this training.

People’s care plans were up to date and demonstrated that families were involved in the development and reviews of care.

Some daily records were not consistent in the information they provided. For example there were inconsistencies in the records completed regarding people’s continence needs being met. This meant that it could be interpreted that people’s continence needs were not always met.

Is the service caring?

We observed that people’s dignity was maintained and saw a positive relationship between the staff and people using the service.

One person using the service told us; “All of the staff are nice, very kind and helpful.” A visitor said: “I don’t have any concerns, I come every day and I haven’t found any problems. The staff always make me feel very welcome.”

Two activities coordinators were employed at the home and on the day of our visit external entertainers were providing musical entertainment at the home. People we spoke with told us that they enjoyed this. One person said; “I thought it was very good, lively and good fun.” Another person said; “I enjoyed that and sang along.”

Is the service responsive?

There was no information in peoples care records regarding their choices and preferences in how they received their care, preferred food and drink and regarding their interests or hobbies. Information provided to the cook was also very limited about people’s meal preferences. This meant that there was no evidence to show that people had been consulted about their preferences to ensure the support they received was personalised to meet their wishes.

We saw that call bells were mostly accessible to people. However we identified that one person’s call bell was not within their reach. This person hadn’t noticed this and confirmed that they had not needed to call for staff support.

Throughout the day we heard call bells being used and these were responded to promptly.

Is the service well-led?

We were informed at this visit that the registered manager had not been working at the service since April 2014. A new manager was in post but they were not available on the day of our visit. We were advised that further plans were in place to change the management of the home in the following weeks.

Staff indicated that over recent months they had not felt empowered to carry out their duties effectively. However it was evident that these concerns had been identified and were being addressed through support from senior managers and the manager of a nearby home which was also owned by the provider.

We looked at the records of complaints received and saw that some complaints did not provide sufficient information regarding the actions that had been taken and the outcome. This meant that there was insufficient evidence to demonstrate that all complaints had been addressed promptly and effectively to ensure people’s welfare was maintained.

We identified at the inspection that we had not been informed about two safeguarding investigations and an injury to a person using the service. This meant that the registered person had not notified the commission, as required regarding these matters.

At our last inspection on 14 June 2013, we made two compliance actions. One was in relation to supporting people who may have a dementia related condition. The other was about records referring to how people had given their consent to care and support. We inspected this service to review how the provider had made improvements to demonstrate they were providing safe care.

We found that suitable and sufficient improvements had been made where we had identified concerns. We saw the provider had put right what was required. This meant the home could demonstrate outcomes for people using the service had improved.

We spoke with 14 people using the service and six visitors. People told us that they were happy with the care and support in the home. We saw that staff provided sensitive support and people were treated with respect. Personal care issues were discussed sensitively and discreetly.

We saw people were dressed in their own style and they told us if they needed support, the staff would help them to continue to take a pride in their appearance.

People could participate in activities in the home including knitting groups, music activities and attend religious services. We saw activities were not always organised to focus on the needs of people with dementia related conditions or for people with complex needs.

The staff understood how people needed to be supported to make decisions when they no longer had capacity. The care records did not always record how people made specific decisions or how decisions had been made in people’s best interests.

Family and friends we spoke with told us they could visit the home whenever they wanted to. People using the service told us family members were able to continue to provide care for them and were involved in providing support.

The quality of care provision was reviewed by the registered person. People using the service and their relatives were asked for their views about the home and regular quality audits were completed to action taken to continually review the service.

We inspected this service in May 2012, and we found the service was not compliant with how medicines were managed, record keeping and managing safeguarding referrals within the dementia unit. We carried out this inspection to check the improvements in these areas. The inspection was unannounced, which meant the provider and the staff did not know we were visiting.

People living in the home were not always able to express their views to us. We observed interaction and saw that people were relaxed with staff and were able to express themselves in gestures.

We only visited the dementia unit as this was where we had identified concerns on our previous inspection. We saw that people's privacy and dignity were respected. We saw staff supporting people to eat and drink and they talked to people whilst giving sensitive support and did not rush them..

We saw one person was transferred from their wheelchair without the use of moving and handling equipment. The technique used could cause harm to people using the service and staff.

Care records were not always up to date and where people did not have the capacity to make their own decisions, a suitable assessment had not been carried out. Important decisions were made for people that the registered person could not demonstrate had been made in their best interests.

We saw improvements in the way medication was managed to ensure medication systems and practices were safe and suitable.

We carried out this visit to check on the care and welfare of people using this service. The visit was unannounced which meant the provider and the staff did not know we were coming. We carried out this visit as part of our schedule of planned inspections.

People we spoke with said they were happy with the support they received. Some people who used the service had special communication needs and used a combination of words and sounds to express themselves. Where people were not able to express their views to us we observed interaction between people and staff. We also used our SOFI (Short Observational Framework for Inspection) tool to help us see what people’s experiences where during the day. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time and whether they have positive experiences. This included looking at the support that was given to them by the staff.

People we spoke with told us that staff were helpful and kind. During our visit we saw examples of staff interacting well with people living in the home. Staff spoke respectfully and it was clear from our observations that people reacted positively when the staff engaged with them. We saw people were supported by suitably recruited and trained staff.

People were provided with choices about how they lived their lives. They told us they chose how they spent their day and had choices over what they ate and drank. People said, “We always have a choice of meals, and they’re very good.” Another person told us, “We can spend time with our friends, or get involved with other things, there’s never any pressure from staff to do anything we don’t want to do.”

There was a range of activities available to people in groups or on an individual basis. These included exercise to music, reminiscence, playing games including marbles and dominoes. People who lived in the dementia care unit had limited opportunities to be involved with organised activities carried out in the residential unit, as these did not always meet people’s needs.

We spoke with people who used the service, who told us they were happy with the support they received. The people we spoke with said they did not have any reason to complain about the service or staff.

Family and friends could visit the home whenever they wanted to, and family members were able to continue to provide care for their relative and spend time in the home. People told us that they went to their families’ homes and continued to enjoy family events, and relatives could accompany them on medical appointments.

We found that the systems to report allegations of abuse were not always carried out. Where concerns had been identified, appropriate referrals and, investigations had not always been taken. This meant people could be placed at risk of harm.

This inspection took place on the 28 January and 2 February and was unannounced. At our previous inspection in August 2014 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There was a breach in meeting the legal requirements regarding respecting and involving people, for staffing, for complaints and for notification of other incidents.

The provider sent us a report explaining the actions they would take to improve and told us the actions would be completed by November 2014.

Poplars Nursing and Residential Care Home provides accommodation, nursing and personal care for up to 60 older people who may have dementia. There were 49 people living at the home at the time of our inspection.

The home is required to have 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 and associated Regulations about how the service is run. There was a registered manager in post.

People we spoke with told us they felt safe living in the home. Staff demonstrated a good awareness of the importance of keeping people safe. They understood their responsibilities for reporting any concerns regarding potential abuse.

Assessments were in place that identified risks to people’s health and safety and care plans directed staff on how to minimise these identified risks. Plans were in place to respond to emergencies to ensure people were supported appropriately.

Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. The provider checked that the equipment was regularly serviced to ensure it was safe to use.

Staff were suitably recruited to ensure the risks to people’s safety were minimised.

Processes were in place to ensure people received their medicines in a safe way.

Staff received training that was appropriate to meet people’s needs and were supported to gain qualifications in health and social care to further develop their knowledge and skills.

The registered manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Staff gained people’s verbal consent before supporting them with any care tasks and promoted people to make decisions but assessments were not always clear regarding people’s capacity to make decisions.

People were supported to maintain good health and accessed the services of other health professionals when they needed specialist support.

People told us that improvements were needed to the quality of the main lunch time meal and the variety of meals at tea time. We saw that people taking lunch in the ground floor dining room had a considerable wait for their meal to be served and their preferences were not always considered.

People told us that they liked the staff and we saw that people’s dignity and privacy was respected by the staff team. Visitors told us that the staff made them feel welcome and were approachable.

People were able to take part in hobbies or interests in a group or individually but felt that more social stimulation was needed.

People and their relatives were involved in planning and agreeing how they were cared for and supported. The care we observed matched the information on people’s care plans.

There were quality assurance checks in place to monitor and improve the service.