This inspection took place on 16 May 2017 and was unannounced. Samuel Hobson House is registered to provide accommodation for people who require nursing or personal care. At the time of our inspection there were 27 people living at the service some of whom were living with dementia.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

People were supported by staff that understood how to safeguard them from abuse and help them manage risks to their safety. Staff were recruited safely and people were supported by sufficient staff to meet their needs and maintain their safety. People received their medicines safely and as prescribed and were supported by staff that had been trained and had their competency assessed.

People received support from staff that had a good understanding of their needs and the skills required to meet them. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People had their dietary needs and preferences met and were offered a choice of food and drink. Staff understood people’s dietary requirements and the support they required. Peoples health and wellbeing was maintained by staff that understood their health needs and accessed support and advice from professionals where required.

People told us they had good relationships with staff and felt they observed their rights to privacy and treated them with dignity and respect. People could describe how staff gave them choices and told us they were encouraged to stay independent.

People had their needs and preferences met by staff that understood them, they were able to spend time doing things they enjoyed and we saw people had the chance to take part in a range of activities. People and their relatives understood how to make a complaint and we could see there was a policy in place to manage complaints.

People and their relatives told us the registered manager was approachable and staff told us they felt able to make suggestions about the service. Staff said they received support in their role from the management team and we could see there were systems in place to ensure people received good quality care.

We inspected this service on 10 April 2015. This was an unannounced inspection.

The service was registered to provide accommodation and nursing care for up to 39 people. At the time of our inspection 17 people were using the service. People who used the service had physical health needs and/or were living with dementia.

Our last inspection took place on 11 November 2014. During that inspection a number of Regulatory breaches were identified. We told the provider that immediate improvements were required to ensure people received care that was; safe, effective, caring, responsive and well-led. At this inspection we found that the required improvements had been made.

The manager of the service was in the process of becoming a registered manager with us. 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 were protected from avoidable harm because risks to people’s health and wellbeing were identified and managed, and the staff understood how to keep people safe. People’s medicines were also managed safely.

There were sufficient numbers of staff to meet people’s needs and keep people safe. Staff received training that provided them with the knowledge and skills to meet people’s needs effectively.

Staff sought people’s consent before they provided care and support. When people did not have the ability to make decisions about their care, the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed. These requirements ensure that where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves.

People were supported to access suitable amounts of food and drink of their choice and their health and wellbeing needs were monitored. Advice from health and social care professionals was sought when required.

Staff treated people with kindness and compassion and people’s dignity and privacy was promoted. People were encouraged to make choices about their care and the staff respected the choices people made.

People and their relatives were involved in the planning of the care and care was delivered in accordance with people’s care preferences. People could also participate in leisure and social based activities that met their individual preferences.

People’s feedback was sought and used to improve the care. People knew how to make a complaint and complaints were managed in accordance with the provider’s complaints policy.

There was a positive atmosphere within the home and the manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

We inspected Samuel Hobson House on 11 November 2014. Samuel Hobson House is registered to provide accommodation and personal care for up to 39 people. People who use the service have physical health and/or mental health needs, such as dementia.

At the time of our inspection accommodation and care was provided to 22 people.

There was no registered manager at 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 and associated Regulations about how the service is run.

The staff told us that the previous registered manager had left the service approximately two weeks before our inspection. Following our inspection, the provider contacted us to inform us they had recruited a new manager. We were not informed if the new manager was planning to register with us.

At the last inspection on 18 March 2014 we asked the provider to make improvements. These were in relation to the content and accuracy of the information contained in people’s care records and how the quality of care was assessed and monitored.

During this inspection we found that the provider had failed to make the required improvements. This meant the provider had continued not to meet the standards required to meet people’s care and welfare needs.

At this inspection, we also identified additional areas of unsafe, ineffective and unresponsive care. This was because the service was not well led. We found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Risks to people’s health and wellbeing were not consistently identified, managed and reviewed and people did not always receive their care in accordance with their care plans. This meant people were not always kept safe and their welfare and wellbeing was not consistently promoted.

There were insufficient numbers of staff to keep people safe and provide the right care at the right time. This also meant that people’s individual needs were not always met and the staff did not have time to consistently treat people with dignity and compassion.

People’s care records were not always accurate, up to date or secure. Information about people’s needs was not always available for the staff to use. This meant people were at risk of receiving unsafe or unsuitable care.

People were not consistently offered choices about their care and care records did not always contain information about people’s care preferences. This meant there was a risk that people’s care preferences may not be met.

People did not always receive the support they required to eat and drink in accordance with their care plans. This meant that people’s risks of malnutrition and dehydration were not always managed.

Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were not being followed. The Mental Capacity Act 2005 and the DoLS set out the requirements that ensure where appropriate, decisions are made in people’s best interests when they are unable to do this for themselves. This meant people could not be assured that decisions were being made in their best interests when they were unable to make decisions for themselves.

There were gaps in the staff’s knowledge and skills because the staff’s training needs had not been assessed and managed. This meant people received inconsistent and unsuitable care from the staff.

The provider did not have effective systems in place to assess, monitor and improve the quality of care. This meant that poor care was not being identified and rectified by the provider.

Effective systems were not in place to seek people’s views about the care. This meant that people’s views were not sought to make improvements to the care.

Systems were in place to store, administer and record people’s medicines. However people’s medicines were not always given in a manner that ensured their safety.

People were supported to access health and social care professionals, but improvements were required to ensure referrals for advice and support were made in a timely manner.

People and their relatives told us the staff were friendly and caring and we saw that people’s privacy was promoted by the staff. Relatives told us they were happy with how the staff communicated changes in people’s needs and they understood how to complain if they needed to share concerns about care.

We carried out this inspection to check that the service had made improvements to the service it provided. At a previous inspection completed on 22 August 2013 we identified areas of non compliance with regulations we inspect against. We asked the provider to tell us how they intended to make improvements for the welfare and safety of people who used the service and when. We returned to undertake another inspection in November 2013 to check if the provider had acted to improve the quality of service. We found improvements had not been made and there was further evidence of poor standards. Following the inspection we issued enforcement notices requiring improvements.

During this inspection we looked at five of the areas of concern identified at previous inspections. We found improvements had been made. The provider had recruited a new manager and deputy manager. Staff vacancies were being filled and the use of agency staff had reduced markedly meaning people who used the service benefitted from support from a staff team that was consistent and familiar.

We saw that improvements had been made to ensure the safety of people who were at risk of falling. We observed that medication management had improved and systems were in place for auditing the service. Although there was evidence of improvement in the monitoring and auditing systems, further development was required to ensure the systems were effective and delivered the improvements required.

At our last inspection on 22 August 2013, we found that the provider needed to make improvements to ensure that people received their care in a safe and timely manner.

During this inspection we checked to see if the required improvements had been made. People who used the service were unable to tell us about their care, so we spoke with four people’s relatives about the care and we observed how people were supported. We spoke with fifteen members of staff (permanent and temporary staff) and the deputy manager. We also spoke with the care manager on the phone during our inspection, and following our inspection we spoke with the provider.

People’s relatives mostly told us they were happy with the care. One relative said, “They cope with X very well”. However, we found that people remained at risk of receiving unsafe or inconsistent care, because information about their needs was not always available. We saw positive interactions between staff and the people, but we saw that that people’s care was not always delivered in a timely manner and in a way that kept them safe.

People were also at risk of harm because appropriate professional advice was not always sought and followed, and effective systems were not in place to manage medicines.

We saw that effective systems were not in place to assess, monitor and improve quality at the home. One relative told us, “Since the registered manager left, the home is in limbo. It’s not progressing at the moment”.

This inspection was completed as part of our schedule of inspections, but also due to concerns that had been raised, regarding the number of falls that had occurred at the home. Our inspection focused on checking how people's risk of falling was managed.

During our inspection we spoke with four people who used the service, five people’s representatives (family or significant other's), six members of staff and a manager.

People mostly told us they were happy with standards of care, but two people’s representatives told us they had concerns about falls. One person’s representative told us, “I can’t fault the care. They have been really good, but I am very concerned about falls. I know they can’t be avoided completely, but I want to know they are doing as much as humanly possible to prevent them”.

We found that people were at risk of falling, because care was not always planned or delivered in a way that managed people’s risks.

We saw that the environment was not always monitored to reduce the risk of falls and there were not always enough staff available to maintain people’s safety.

We could see that systems were being developed to assess and monitor quality, but these systems were not yet effective.

At our last inspection, we found that improvements were required to ensure people were protected from the risks associated with medicines. During this inspection, we saw that some improvements had been made, but further improvements were required.

Some of the people who used the service were unable to communicate with us due to the nature of their disabilities. Relatives of people who used the service told us they were happy with the care provided. One relative said, “My relative is safe and looked after”. Another relative said, “I am really pleased with the care here. I have peace of mind, knowing that my relative is clean, warm and safe”.

During our inspection we saw that people were supported to make simple decisions and when people were unable to make decisions for themselves the provider acted in accordance with legal requirements.

We saw that staff interacted with people in a positive and caring manner and saw that staff had undergone the appropriate pre employment checks to ensure that people were protected from harm.

We found that although systems were in place to manage the risks associated with medicines, they were ineffective during our inspection. This meant that the provider was unable to identify if some people’s medicines had been given as prescribed.

We saw that there was a complaints system in place, and relatives we spoke with told us they would feel comfortable approaching staff to make a complaint if required.

We saw that people's care records contained detailed information about their needs. Care records were updated in response to professional recommendations. This meant that accurate information was available to staff to enable them to provide the care that people required.

We visited Samuel Hobson House on 28 March 2012, on the day of our visit we spoke with six people who lived at Samuel Hobson House and seven relatives. We also spoke with five members of staff, the registered manager and the deputy manager.During our visit we had the opportunity to speak to the district nurse.

People we spoke with during our visit were overall happy with their care. People told us

they were comfortable. People reported staff were caring and they could approach them with a concern. One person commented “it’s very nice I am happy here”.

A number of people were not able to express their views due to health conditions. We were able to look at other areas for evidence to support their experience such as speaking to family members and staff. We also looked at care records and observed care given.

The relatives we spoke with were happy with the care received by their family members. Relatives said they felt involved and staff kept them informed of any changes which occurred.

The district nurse reported staff were always helpful during their visits and staff treated people using the service with dignityand respect.

We saw staff attended to people in a caring, considerate manner and responded

appropriately to their needs. People's likes, dislikes and religious beliefs were known by

staff and included in the delivery of care. For example one person had a vegetarian diet staff were aware of this, during lunchtime we saw the person was given a suitable meal.

Staff we spoke with showed understanding in areas such as privacy and dignity as well as manual handling. Staff told us they liked working at Samuel Hobson House and felt well trained and supported to provide good quality care. Staff understood what constituted abuse and said that they were able to recognise and report poor practice. This demonstrated people were cared for by appropriately trained staff.

We found there were good monitoring systems in place; we saw evidence of action taken when trends were identified as a result of audits undertaken.