This inspection took place on the 14 and 17 May 2018 and was unannounced. At the previous inspection of this service in February 2017 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 9, 11 and 17. This was because the provider had not ensured that people received person centred care and the risk of social isolation had not consistently been mitigated. The registered provider had failed to maintain accurate, complete and contemporaneous records and the principles of the Mental Capacity Act (MCA) 2005 had not been consistently applied in practice.

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 safe, effective, responsive and well led to at least good. This inspection found improvements had been made and the breaches of regulation met but improvements were needed in well-led to ensure that quality assurance systems were further improved and embedded in to every day practices.

Quinnell House 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. Quinnell House was registered to provide support to a maximum of 56 people who lived with dementia. The service does not provide nursing care on site and used district nurses to provide support when needed. 38 people were living at Quinnell House at the time of our inspection.

The service had a 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.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan as stated in their provider information return (PIR), and confirm that the service now met legal requirements. We found improvements had been made in the required areas. The overall rating for Quinnell House has been changed to good. We will review the overall rating of good at the next comprehensive inspection, where we will look at all aspects of the service to ensure the improvements have been sustained.

The provider undertook quality assurance reviews to measure and monitor the standard of the service and drive improvement. However, we found that audits were not consistently effective as they had not identified shortfalls in the management of diabetes and not all records to support the care delivered were consistently completed.

People told us they felt safe and there were sufficient staff to support them. When staff were recruited, their employment history was checked and references obtained. Checks were also undertaken to ensure new staff were safe to work within the care sector. Medicines were managed safely and in accordance with current regulations and guidance. There were systems in place to ensure that medicines had been stored, administered, audited and reviewed appropriately. Risks associated with the environment and equipment had been identified and managed. Emergency procedures were in place in the event of fire and people knew what to do, as did the staff. Staff were knowledgeable and trained in safeguarding adults and what action they should take if they suspected abuse was taking place. Staff had a good understanding of Equality, diversity and human rights. Accidents and incidents were recorded appropriately and steps taken to minimise the risk of similar events happening in the future.

Staff had received essential training and there were opportunities for additional training specific to the needs of the service, including the care of pe

We inspected Quinnell House on 6 and 7 February 2017. This was an unannounced inspection. Quinnell House provides accommodation and support for up to 51 people living with dementia. The service no longer provides nursing care on site and uses district nurses to provide support when needed. On the days of our inspection, there were 43 people living at the service. The accommodation is provided in an older style detached building in a residential street. There is a communal lounge, dining room, kitchen, communal bathrooms and bedrooms with en-suite bathrooms. There is also a sensory room and treatment room for use of GP and district nurses.

A manager was in post but they were not the registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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. The manager had been in post nearly six months and was in the process of applying to become the registered manager.

At the last inspection undertaken on the 19 and 20 April 2016, we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014 in relation to the principles of the Mental Capacity Act 2005 not being adhered to. People’s confidential information had not been maintained and the delivery of care was not consistently person-centred. Recommendations were also made in relation to the use of ‘as required medicines’ and maintaining accurate and complete records. The provider sent us an action plan stating they would have addressed all of these concerns by June 2016. At this inspection we found the provider had made improvements to the management of ‘as required’ medicines and people’s confidential information. However, improvements were not yet fully embedded and the provider continued to breach the regulations relating to the other areas.

The principles of the Mental Capacity Act (MCA) 2005 were still not consistently applied in practice. People’s capacity to consent to the use of bed rails and their bedroom door being locked had not been assessed. Where people were unable to use their call bell to summon assistance, risk assessments were not consistently in place. For people who required two hourly checks to maintain their safely, documentation failed to support that these checks took place.

The risk of social isolation had not consistently been mitigated. The registered provider had failed to maintain accurate, complete and contemporaneous records. People’s monitoring charts were incomplete and failed to evidence the level of care that people received. Documentation was in place for the recording of incident and accidents. However, subsequent follow up information was not recorded and incidents and accidents were not audited for any emerging trends, themes or patterns. We have made a recommendation for improvement.

People received their medicines on time and safely. Medicine profiles were in place alongside clear protocols for the use of ‘as required’ medicines. However, where people received covert medicines (medicines disguised in food), underpinning documentation was not available to confirm whether the person consented to this or whether it was done in their best interest. We have made a recommendation for improvement.

End of life care plans were not yet consistently in place. Weekly cleaning schedules for the kitchen had not been maintained and the extraction hood in the kitchen had a layer of dust and grease. We have made recommendations for improvement.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people's freedom had been submitted.

The registered provider and manager were committed to the on-going improvement of Quinnell House. The

We inspected Quinnell House on 19th and 20th April 2016. This was an unannounced inspection. The service provides accommodation and support for up to 51 people living with dementia. The service no longer provides nursing care on site and uses district nurses to provide support when needed. At the time of inspection there were 48 people living at the service. The service provides en-suite rooms over two floors and has a lift. There is one large communal lounge, two smaller communal lounges, a sensory room, dining room, kitchen, treatment room for use of GP and district nurses, laundry, cinema room and a function room that is made available for private occasions.

There was a manager in post who was registered with the CQC. 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 trained to protect people from abuse and harm. Staff could identify the signs of abuse and who to report to if they had any concerns. The provider had in place policies and procedures to record, investigate and track any safeguarding concerns. Staff were aware of these policies and procedures.

There were sufficient numbers of staff to keep people and safe and meet their needs. The provider had a system in place that allowed the register manager to recruit more staff when the numbers of people living at the home increased.

Medicines were stored and disposed of safely. Staff were trained in the safe administration of medicines. However, there were gaps in the application of creams. This could put people at risk, as there could have been applications that were missed. We have made a recommendation about this in our report.

The principles of the Mental Capacity Act (MCA) were not consistently applied in practice. Where people were unable to give consent to aspects of their care an assessment of their capacity had not always been completed. This put people at risk as staff could make assumptions about their ability to make their own decisions.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate application to restrict people’s freedom had been submitted and the least restrictive options were considered as per the Mental Capacity Act 2005.

People were supported to maintain a balanced diet. People were provided meals that met their nutritional needs and choice preferences. The provider had carried out assessments of people to identify those at risk with their eating and drinking.

People were supported to maintain good health. People were being referred to appropriate health professionals when needed. This included referrals to GPs, district nurses and dieticians.

The provider had not ensured that all information was provided in format to meet people’s varied communicational needs. We have made a recommendation about this in our report.

People told us they were happy with the staff and felt supported with their care. Staff were seen to be communicating with people in a kind and caring way.

People and their relatives were not always involved with the reviews of care plans. Staff would carry out regular reviews of care plans and the registered manager sent out letters to relatives to inform them of reviews, however, some people told us they had not seen a care plan. People had pre-admission assessments that gave staff basic information. However, detailed care plans were not developed in time to give people full support during their first days at the service.

People’s private information and personal documentation was not always respected and stored securely. Handover took place in a communal area with people living at the service in the same room. People’s care plans were kept in a ro