About the service: Savile House is a residential care home that was providing personal care to 14 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

People and relatives were happy with the care provided at Savile House. They told us staff were good and kind and treated them with respect. People were given choices and able to make decisions about their daily lives. People received personalised care and this was reflected in their care records.

There were enough staff to meet people’s needs and keep them safe. Recruitment processes ensured staff were suitable to work in the care service. Staff were well trained and supported by a registered manager who worked with them providing direction and guidance.

Staff understood how to manage any risks to people and knew the processes to follow to manage any allegations of abuse. People’s health care needs were well managed and they received their medicines when they needed them.

Activities were available and people were supported to go out in the community. People’s dietary needs were met although there was mixed feedback about the food. The registered manager was working with the chef to make improvements.

The home was clean and well maintained. Many areas of the home had been decorated and refurbished and this process was ongoing.

A complaints procedure was displayed. People and relatives knew how to raise concerns and were confident these would be dealt with appropriately.

People, relatives and staff praised the management of the home and spoke highly of the registered manager. The registered manager was committed to making the service the best it could be for the people who lived there. Effective audits and checks helped them in this process.

Rating at last inspection: At the last inspection the service was rated Requires Improvement (report published 5 February 2018).

Why we inspected: This was a planned inspection based on the rating awarded at the last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 4 January 2018 and was unannounced.

At our last inspection on 4 and 5 October 2017 we rated the service as ‘Inadequate’ and identified six breaches which related to staffing, safe care and treatment, person-centred care, consent, safeguarding and good governance. The service remained in 'special measures' which it had been at our previous inspections in November 2016 and April 2017.

At this inspection we found improvements had been made and the breaches had been addressed. We have now rated the service overall as ‘Requires Improvement’.

Savile House provides personal care for up to 24 older people, some of who may be living with dementia. There were 15 people using the service when we visited. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are communal areas on the ground floor, including a lounge, dining room and conservatory.

The home has a manager who has applied for registration with the Care Quality Commission. 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 found the provider, manager and staff had worked hard to make improvements. People told us they felt safe and no concerns were raised about the staffing levels. Although care staffing levels remained the same, additional measures had been put in place to ensure care staff did not have to complete cooking, cleaning and laundry tasks on a regular basis. We have made a recommendation that the provider keeps staffing levels under review to make sure there are sufficient staff to respond to people’s needs.

Safe recruitment procedures were in place which helped ensure staff were suitable to work in the care service. Staff received the training and support they required to carry out their roles and meet people’s needs. Training updates were being arranged for some staff.

We found improvements in the way people’s medicines were managed which meant people received their medicines when they needed them. However, there were ongoing problems with the dispensing pharmacy which the manager was taking action to address.

Staff’s understanding of safeguarding procedures had improved and they knew how to report any concerns. Safeguarding incidents had been identified and referred to the local safeguarding team and reported to the Commission. Risks to people were assessed and managed to ensure people’s safety and well-being.

The home was clean, comfortable and bright. Many areas of the home had been refurbished and redecorated and this was ongoing.

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’s care plans had improved and the electronic care record system was being used. Further development was planned to make sure the care records were more person-centred. People had access to healthcare services such as GPs, district nurse, dentist and chiropodist.

People’s nutritional needs were met. People were offered choices and given the support they required from staff. People's weights were monitored to ensure they received enough to eat and drink.

People told us they liked the staff. We saw staff were kind, patient and caring in their interactions with people. People told us they were treated with respect and this was confirmed in our observations. People looked clean, comfortable and well groomed. A range of activities were provided.

The complaints procedure was displayed. Records showed complaints received had been dealt with appropriately.

We found the leadership and management of the home had improved. The provider h

This inspection took place on 4 and 5 October 2017. The first day was unannounced. At the previous two inspections in November 2016 and April 2017 we rated the service as ‘Inadequate’ and in ‘Special Measures’. At our inspection on 11 April 2017 we found eight regulatory breaches which related to staffing, safe care and treatment, dignity and respect, person-centred care, consent, recruitment, good governance and failure to display a rating. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Savile House provides personal care for up to 24 older people, some of who may be living with dementia. There were 16 people using the service when we visited. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are communal areas on the ground floor, including a lounge, dining room and conservatory.

The registered manager left in February 2017. One of the senior staff had recently been appointed as the manager and had been in post for a month at the time of our inspection. The provider told us this person would be applying for registration with the Care Quality Commission. 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 staffing levels remained the same as they had been at our last inspection in April 2017 when 18 people had been using the service. However, we found there were still times when there were not enough staff to meet people’s needs, particularly at night and weekends. Staff induction was not thorough as it did not ensure staff had the competencies and skills required to complete their roles. Similarly there were significant gaps in staff training and supervision which meant we could not be assured staff had received the training, updates and support they required.

Staff recruitment had improved and we found appropriate checks had been completed before new staff started work.

Medicines were stored safely and appropriately. However, we found a lack of consistency in the way medicines were managed which meant we could not be assured people were receiving their medicines as prescribed or when they needed them.

Individual and environmental risks were not always well managed which placed people at risk of harm or injury.

Staff understood safeguarding procedures and some incidents had been referred to the local authority safeguarding team. However, we found other incidents had not as they had not been recognised as potential abuse. Following the inspection we made a referral to the local authority safeguarding team.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible.

People had access to healthcare services such as GPs, district nurses and chiropodist.

A new electronic care documentation system was being put in place, however this was not operational at the time of our inspection and staff were working from paper care records. We found these were not always up-to-date or accurate which placed people at risk of receiving inconsistent and inappropriate care.

People told us they enjoyed the meals and we observed the lunch time meal was a sociable occasion. Daily activities were provided by the care staff and we saw people enjoying a quiz and a game of skittles. People told us the staff were kind and caring. Overall, people’s privacy and dignity was respected however we found two instances where this was not the case.

People told us they knew how to make a complaint and the complaints procedure was displayed. No complaints had been

This inspection took place on 11 April 2017 and was unannounced. At the last inspection on 17 November 2016 we rated the service as ‘Inadequate’ and in ‘Special Measures’. We found eight regulatory breaches which related to staffing, nutrition, safe care and treatment, dignity and respect, person-centred care, premises, recruitment and good governance. Following the inspection the provider sent us an action plan which showed how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Savile House provides personal care for up to 24 older people, some of who may be living with dementia. There were 18 people using the service when we visited. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are communal areas on the ground floor, including a lounge, dining room and conservatory.

The registered manager left in February 2017 and the deputy manager has been appointed as the manager of the home. The provider told us the manager would be applying for registration with the Care Quality Commission. 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 manager was not working on the day of this inspection; however the provider attended and received feedback from us at the end of the day. Overall we found limited progress had been made in improving the quality of service for people at Savile House.

Although the provider had increased the staffing levels, people told us there were not enough staff to meet their needs, particularly at night. Our observations confirmed this, as there often were no staff present in communal areas and on at least three occasions we had to go and find staff to assist people who needed help.

Staff recruitment checks were not always completed before new staff started work as we saw a reference for one new staff member was dated three days after they had started employment. Our review of records and discussions with new staff showed the induction process was not thorough. Staff competencies and skills to do the job had not been ascertained before they worked unsupervised, placing the people to whom they provided care at risk of unsafe and inappropriate care. Some staff training had taken place since the last inspection.

Medicines were stored safely and appropriately. However, we found a lack of consistency in the way medicines were managed which meant we could not be assured people were receiving their medicines as prescribed or when they needed them.

Individual and environmental risks were not well managed. For example, although incident reports showed one person’s behaviour posed risks to other people there was no plan in place to show how these risks were being managed to protect people. Although there were some environmental risk assessments, not all areas of risk had been considered or managed. A gas fire in use in the dining room was unguarded posing the risk of burns or accidental contact with combustible materials. Adaptations had been made to the communal toilets on the ground floor however people who required a hoist to transfer were still not able to use these facilities in a way that maintained their privacy and dignity. Staff told us they struggled to use the hoist safely due to space restrictions and the layout of these rooms.

Staff had limited understanding of safeguarding and whistleblowing procedures. Although we saw some incidents had been referred to the local authority safeguarding team we found other incidents had not as they had not been recognised as potential abuse.

People were not supported to have maximum choice and control of their lives and staff did not always supp

This inspection took place on 16 November 2016 and was unannounced. At the last inspection on 22 October 2015 we rated the service as ‘Requires Improvement’ and found the service was meeting the regulations.

Savile House provides personal care for up to 24 older people, some of who may be living with dementia. There were 17 people using the service when we visited. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are communal areas on the ground floor, including a lounge, dining room and conservatory.

The home has 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.

Prior to this inspection we had received concerns about the management of the home, staffing levels, moving and handling practices and the suitability of the premises when people required the use of a hoist. We identified the same concerns during the inspection.

Due to personal circumstances the registered manager had taken several periods of leave over recent months which had left the deputy manager in charge of the home and this situation was ongoing. We were concerned the deputy manager was inexperienced and was not provided with the resources and support required to take on this role. The deputy manager had two days a week in the office and the rest of the time was included in the staffing numbers as part of the care team delivering care to people while at the same time managing the service. We informed the provider of our concerns during the inspection and made referrals to the Local Authority safeguarding team where we identified people were at risk.

There were not enough staff deployed to meet people’s needs. Staff rotas showed the levels of care staff frequently fell below the levels the registered manager told us were in place. Staff who did the cleaning and worked in the laundry and kitchen were employed part time and when they were not present these tasks were completed by the care staff. We saw care staff making the tea time meal and breaking off to assist people to the toilet before returning to the kitchen. Although they washed their hands and changed protective clothing this was not acceptable.

Risks were not well managed. There were no arrangements in place to ensure that people who required a hoist to transfer were provided with suitable accommodation to allow this to be done safely. For example, none of the communal toilets on the ground floor could accommodate a wheelchair and hoist safely or in a way that maintained people’s privacy and dignity. Moving and handling assessments and care plans provided conflicting advice about the equipment and aids to be used. Medicines were not managed safely or effectively which meant we could not be assured people were receiving their medicines as prescribed or when they needed them.

Recruitment procedures were not always robust. For example, there was no evidence to show appropriate action had been taken in response to concerning information received through recruitment checks for one applicant.

Staff received induction and training however, we found this was not always thorough. For example, we identified one staff member did not have the skills or competency to carry out their role. We raised this with the provider who took immediate action to address the matter and stated they would provide them with additional training. However, we were concerned this had not been identified by the registered manager or provider through their own processes.

People told us they enjoyed the food and we saw staff supported people with their meals. However, we found the systems in place to monitor people’s weight and to make sure they had enough

This inspection took place on 22 October 2015 and was unannounced. At the last inspection on 9 July 2015 we found the home was meeting the regulations.

Savile House provides personal care for up to 24 older people, some of who may be living with dementia. There were 17 people using the service when we visited. Accommodation is provided on three floors, there are single and shared rooms and some have en-suite facilities. There are communal areas on the ground floor, including a lounge, dining room and conservatory.

The home has 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.

People told us they felt safe in the home and our discussions with staff showed they knew how to recognise abuse and report any concerns to senior staff. The registered manager and senior staff knew the reporting systems and had taken appropriate action to report one allegation. Risks to people were well managed which kept them safe without unduly restricting their freedom.

Safe medicine systems ensured people received their medicines when they needed them and people had access to healthcare services. People received the care and support they needed from staff who were appropriately trained and supported to meet individual needs and preferences. Care records were accurate and up to date and guided staff in care delivery. Recruitment procedures ensured staff were suitable and safe to work with people.

The registered manager understood the legal requirements relating to the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS). An authorised DoLS was in place for one person and two other applications had been made for DoLS authorisations.

During our inspection we observed there were enough staff to meet people’s needs and no concerns were raised by people who used the service or their relatives. However, our discussions with the registered manager and staff and review of the duty rotas showed there were times when care staff had to undertake cleaning, cooking and laundry duties in addition to their care role. This was because there were times each day when there were no ancillary staff employed to complete these duties, which meant care staff had less time to spend caring and supporting people who used the service. We raised this with the registered manager who agreed to review the staffing levels.

We found the home was clean and odour free. Bedrooms and communal areas were comfortably furnished and there was an ongoing refurbishment programme. The home was generally well maintained although we identified some issues relating to hot water temperatures, radiators and window restrictors. We raised these with the provider and registered manager and they were addressed straightaway.

Activities were provided in-house, however this was dependent upon the availability of care staff as there was no activity organiser employed. Opportunities for people to go out were limited although some people told us they went out with their relatives. We have made a recommendation about activity provision.

People told us the staff were kind and caring. We saw people’s privacy and dignity was respected and maintained. People’s comments about the food were mixed as some people praised the meals and others were less positive. We saw mealtimes were well organised and relaxed with staff providing people with support as needed. People’s weight was monitored and action was taken to ensure nutritional needs were met.

Safe systems were in place to manage medicines which ensured people received their medicines when they needed them. People knew how to make a complaint and we saw complaints received were investigated and the outcome fed back to the complainant.

Systems were in place to monitor and assess the quality of the service. Such as audits, quality questionnaires and care plan reviews. These systems were not always effectively used to identify and address areas for improvement to ensure that the quality of care continually improved. We have made a recommendation about quality assurance.

We spoke with seven people who lived at the home, one relative, one visitor, two members of staff and a district nurse. These are some of the things they told us:

“The staff are all very kind and helpful.”

“The home is always clean and tidy with no offensive odours.”

“The home has a nice feel and I enjoy coming here.”

“My relative is well cared for and I am very happy with the home.”

“I enjoy working here, we have a good staff team.”

We found that people had been involved in planning and reviewing their care and support. We saw from the records that staff were delivering care and support in line with people’s care plans. People looked well cared for and were being encouraged to follow their individual interests.

We spoke with many of the people living in the home. They all told us that they like the staff and they get the care and support they need, in the way they prefer. People were complimentary about the meals, the laundry service and the cleanliness of the home. One person said “my family made a good choice, Savile House is very homely and I have been happy since I came here.” Another person said “Staff are willing to do anything you want and talk to me about the help I need. They do as much as they can for everyone.”