This comprehensive inspection took place on 27 and 28 November 2018. The inspection was unannounced.

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home. The home is arranged over four floors. Each floor is separated into two units. A central staircase and two lifts provide access to each floor. The provider is also registered to provide personal care to people living in self-contained purpose-built apartments next to the home. At the time of our inspection one person living at those apartments received the regulated activity personal care.

The registered manager had been in post since July 2017. 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.

At the inspection of October 2017 significant improvements had been made but further improvements were required. We also needed to be satisfied the improvements that had been made would be sustained. We found that management of medicines required further improvement and risks assessments required more detail to protect people from unnecessary harm. Training had improved but staff still required training in how to care for people with dementia. Consent to treatment and support was not clearly evidenced. Systems in place to monitor and evaluate the service needed to improve. Following the inspection, the provider sent us an action plan explaining how they would address our concerns and what action would be taken.

At this inspection we found continued significant improvements had been made and all previous breaches in regulations had been met. This meant the overall rating of the service had changed from Requires Improvement to Good.

Why the service is rated good

People now received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm. People were supported to take risks, promote their independence and follow their interests. Risks were assessed and plans put in place to keep people safe. There was enough staff to safely provide care and support to people. Checks were carried out on staff before they started work to assess their suitability to support vulnerable people. Medicines were well managed and people received their medicines as prescribed. The home was exceptionally clean and staff followed infection control procedures.

Improvements had been made to promote and provide an effective service. Staff received supervision and the training required to meet people’s needs. Arrangements were made for people to see a GP and other healthcare professionals when they needed to do so. The registered manager and staff understood the principles of the Mental Capacity Act (MCA) 2005 and, worked to ensure people's rights were respected. People were supported to enjoy a healthy, nutritious, balanced diet whilst promoting and respecting choice.

The service remained caring and put people at the heart of everything they did. We were introduced to people throughout our visit and they welcomed us. They were relaxed, comfortable and confident in their home. The feedback we received from them was extremely positive throughout. Those people who used the service expressed satisfaction and spoke well about the staff. Staff had a good awareness of individuals' needs and treated people in a warm and respectful manner. They were knowledgeable about people's lives before they started using the service. Every effort was made to enhance this knowledge so that their life experiences remained meaningful.

The service continued to be responsive. People received person centred care and support. Regular monitoring and reviews meant that r

This comprehensive inspection took place on 18 and 19 October 2017. The inspection was unannounced, this meant the staff and provider did not know we would be visiting.

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home. The home is arranged over four floors. Each floor is separated into two units. A central staircase and two lifts provide access to each floor. The provider is also registered to provide personal care to people living in self-contained purpose built apartments next to the home. At the time of our inspection no-one living at those apartments was receiving personal care.

At our last comprehensive inspection in September 2016 we found breaches of four of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We rated the service as Requires Improvement. Following that inspection we told the provider to send us an action plan detailing the measures they would take to make the necessary improvements.

We then carried out a focussed inspection in July 2017. The purpose of that inspection was to follow up on safeguarding concerns shared with us. As a result we inspected and reported upon whether the service was safe. We found the service required improvement in that key question area and identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following our inspection we told the provider to submit a further action plan detailing the measures they would take to make the necessary improvements.

Overall, at this inspection we found improvements had been made and many of the actions detailed in the provider’s action plans achieved. However, we found improvements were still required to ensure the service provided to people is consistently safe, effective and well-led.

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. The previous registered manager had left the service in July 2017. A new manager commenced in July 2017 and has submitted an application for registration to the Care Quality Commission.

People were not always kept safe because medicines were not well managed. Medication administration records were not always completed. This meant it was not possible to be sure people had received their medicines as prescribed. Guidance for when people should be offered PRN (as required) medicines, did not provide enough detail. The recording and storage of medicines was not thorough enough to ensure safety at all times.

The service had not consistently complied with the requirements of the Mental Capacity Act 2005 (MCA). People’s capacity to make their own choices and decisions had not always been assessed. Where people had been identified as not having the capacity to make a particular decision, decisions made on their behalf were not always arrived at in a manner consistent with the principles of the MCA. Some people were being deprived of their liberty without this being correctly identified and authorisation applied for.

Staff received basic induction and update training but had not had training to equip them with the knowledge and skills to effectively care for people living with dementia.

Quarry House is a newly built modern facility that following registration with CQC opened in January 2016. It was well equipped and the physical environment was clean and fresh. However, it was lacking in stimulation for older people and particularly those living with dementia. The provider and manager had identified some ideas for improving this. In order to best make progress with this, the manager and provid

We carried out a focused unannounced inspection of Quarry House on 20 July 2017. Prior to this inspection, we had received concerns about the health, safety and welfare of people living in the home. The concerns related to staffing levels, the deployment of staff within the home and the impact this had on the care and support people received. Concerns had been received from local authority safeguarding and quality monitoring teams and from staff working in the home.

We undertook this focused inspection to ensure that people living in the home were safe, and that there were sufficient staffing arrangements in place to make sure people’s care needs were being met. This report only covers our findings in relation to these areas. When we last inspected Quarry House, in September 2016, we found that staffing was insufficiently deployed and did not always meet people’s care and treatment needs. You can read the report from our last comprehensive inspection, by selecting the ‘All reports’ link for Quarry House on our website at www.cqc.org. The current overall rating for the home is ‘Requires Improvement.’

Quarry House is registered to provide accommodation for up to 65 people who need nursing or personal care. At the time of our visit, 61 people were living in the home.

There was no registered manager in post at the time of our visit. The current manager had commenced in post in January 2017. They were leaving Quarry House on 21 July 2017. Another manager had started one week before our visit. They told us they would be applying to the Care Quality Commission, (the Commission), to be the registered manager for the 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.

People who used the service and their relatives provided mixed feedback about staffing. Staff were not always confident they could meet the care needs of people living in the home. Staff were also concerned that further changes in management would affect the support they received.

Staff were not always sufficiently deployed to provide the care and support people needed and when they needed it.

We found there continued to be a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we had identified at our last comprehensive inspection undertaken in September 2016. You can see what action we told the provider to take at the back of the full version of the report.

We carried out a comprehensive inspection on 12 and 13 September 2016. The inspection was unannounced and was the first inspection undertaken since Quarry House opened in January 2016. Quarry House is a 65 bed home that provides accommodation for persons who require nursing and personal care. At the time of our inspection there were 59 people living in the home.

There was a registered manager in place at the time of our 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.

Staff were not always deployed where they were needed to meet the needs of people living in the care home. Care was sometimes rushed and staff told us they did not always have time to provide the care people needed.

People’s medicines were not always managed safely. We found that incidents and accidents were not fully reviewed and insufficient actions were taken to minimise future risks to people.

Staff had not received sufficient training to carry out their roles effectively. Staff had not received training to ensure they could always meet people’s needs and care for them in a safe way. There was inconsistency in the knowledge and understanding staff had about Deprivation of Liberty Safeguard (DoLS). Staff were not all aware of people who had authorisations in place or who had conditions attached to authorisations. This meant people rights may not be fully protected.

People and their relatives spoke positively about the staff and told us staff were kind, caring and respectful. We spoke with staff and with relatives who told us staff did not always get to know about people’s individual needs and preferences because staff were often moved to work in different areas of the home.

There was a range of group activities that people could participate in and people were enjoying group activities on the days of our inspection.

Quality assurance systems were partly in place. These had identified some, but not all of the issues we identified during the inspection.

We found multiple breaches of the regulations at this inspection. You can see what action we told the provider to take at the back of the full version of the report.