We carried out an unannounced comprehensive inspection in October 2017 at which time the service was rated good in all areas.

Following on from that inspection we received information of concern in relation to the safe care and treatment of people and poor management and oversight of the service. As a result we undertook a focused inspection on 27 April and 4 May 2018 to look into those concerns.

This report only covers our findings in relation to those topics at that time. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Seven Arches Nursing Home on our website at www.cqc.org.uk.

This inspection took place on 27 April and 4 May 2018 and was unannounced. During the inspection we found that the registered manager and provider had failed to consistently and reliably assess and mitigate risks to people and monitor and improve the quality and safety of the service. We therefore found the service in breach of Regulation 12, 13 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of the Care Quality Commission (Registration) Regulations 2009 (Part 4).

People were not protected from the risk of abuse as staff training in safeguarding was not always up to date. In addition, potential safeguarding concerns had not always been identified, investigated or reported appropriately.

Accidents and incidents were not reliably monitored and analysed which meant that appropriate preventative measures had not been put in place to minimise the risk of re-occurrence.

We found evidence of poor risk management relating to the use of bedrails, which when used appropriately can reduce the risk of a person from falling from bed. The registered manager demonstrated a lack of understanding of how to manage the risks associated with bedrails whilst at the same time protecting people’s rights and freedom.

Poor planning and management of risk was found in relation to the lift being out of service and risks to people had not been considered or assessed which meant there was the potential for harm or injury of people and staff due to unsafe practices.

Written records did not always accurately reflect risks to people or how these were being managed. In addition, the monthly of the risks to people were hand-written and were sometimes illegible which posed a potential risk with regard to information sharing around risk .

The arrangements to ensure fire safety at the service were not robust. Not all staff had received the necessary training and the fire risk assessment had not been regularly reviewed. Recommendations made by an independent fire safety risk assessor had not been always been followed.

We have made a recommendation that the provider seek advice from an independent source to ensure all necessary fire safety measures were in place for the safety of people and staff in the event of an emergency evacuation.

The registered manager had failed to notify us when the lift broke down. This meant they were not meeting the legal requirements of their registration. The registered manager also demonstrated an inconsistent and inaccurate approach to record-keeping. This meant they were not able to reliably oversee and monitor many aspects of the service such as staff training and supervision.

The registered manager and provider were unable to demonstrate robust oversight of the service. The quality assurance systems in place were ineffective as had failed to identify and address the issues we found during our inspection.

Improvements had been made in response to feedback from the local authority with regard to the safe administration of medicines whilst the lift was out of operation.

Checks had been made to ensure staff were suitable to work with vulnerable adults and there were sufficient staff employed to safely meet people’s needs.

Infection control audits had been sporadic and staff training was not always up to date. However, the serv

The inspection took place on 4 and 5 October 2017 and was unannounced.

Seven Arches is a nursing home which is registered to provide nursing care and accommodation for up to 30 people. At the time of inspection there were 30 people using the service. When we last inspected the service in 2015 it was rated good. At this inspection we found the service remained good.

Medicines were managed safely by staff who had been trained and assessed as competent to administer medicines. We have made a recommendation that the service review their storage practices for powders used to thicken fluids. thickeners.

People were protected from harm as staff had been trained how to protect people from the risk of abuse. Staff were aware of the reporting process and understood their responsibilities to share any concerns.

Risks to people were identified and regularly reviewed. Written guidance was provided to staff on how to manage risks to keep people safe. Staff had a good knowledge of the risks to people and knew what to do to minimise risk.

There were systems in place for the safe recruitment of staff with sufficient staff deployed to meet people’s needs.

Staff followed good infection control practices, wearing of gloves and protective aprons to prevent the spread of infection. However, people's personal equipment for moving and positioning had not been clearly labelled and designated for sole use which represented an infection control risk. We have made a recommendation that the service improve its system for labelling moving and positioning equipment and providing clear guidance for staff.

Staff had access to regular training to support them to maintain and develop their skills and knowledge. Staff were supported through supervision, observations and appraisals to help them develop professionally. We have made a recommendation that the provider review aspects of their clinical training programme to promote the continuous professional development of nursing staff.

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 enough to eat and drink and the food was of a good quality. The service supported people to maintain their health and wellbeing and people were supported to access healthcare services and any treatment required promptly.

The service listened to people and involved them in planning how their care and support would be provided. Staff were kind and courteous and communication between staff and people was friendly and respectful.

Staff knew people well, could describe their routines and preferences and understood how to provide care and support that was tailored to each individual. People were provided with opportunities to engage in activities which reflected their interests and preferences both within the service and out in the community.

The service listened and responded positively to feedback from people, relatives and staff. There were procedures in place to manage complaints and the registered manager responded to complaints appropriately.

The registered manager was well thought of by staff and people and was hands-on and visible within the service. This promoted a positive culture with a strong emphasis on teamwork.

Quality assurance systems were in place to assess and monitor the quality of service that people received and identify areas that required improvement.

Further information is in the detailed findings below.

The Inspection took place on 26 August 2015 and was unannounced. Seven Arches is registered to provide care and support for up to 30 people who may have a physical, medical or dementia related condition. On the day of our visit 24 people were living in the home.

The home had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manager 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 Care Quality Commission (CQC) monitors the operation of the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS) which apply to care homes. We found the provider was following the MCA code of practice and meeting the requirements of DoLS.

The service had appropriate systems in place to keep people safe and staff followed these processes when they supported people. There were sufficient numbers of care staff available to meet people’s care needs and there were systems in place to manage medicines safely. The provider also had a robust recruitment process in place to protect people from the risk of avoidable harm.

People’s health needs were met with input from relevant healthcare professionals and people were supported to receive food and drink that met their nutritional needs and preferences.

Staff were attentive to people’s needs and respected their privacy and dignity. People were treated with kindness and respect by staff who knew them well and who listened to their views and preferences.

There were processes in place to involve people in making decisions about their care and support. People were encouraged to follow their interests and hobbies, and were supported to keep in contact with their family and friends.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This visit was unannounced, which meant the provider and staff did not know we were coming. At the last inspection in July 2013 the provider met all the requirements we looked at.

Seven Arches Nursing Home is registered to provide accommodation and support for 30 adults who may have a physical, medical or dementia related condition. On the day of our visit, there were 30 people living in the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People who used the service told us they felt safe, were treated with kindness, compassion and respect by the staff and were happy with the care they received.

Staff knew how to recognise and respond to abuse correctly. People who used the service were protected from the risk of abuse because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

The CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA), and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We looked at whether the service was applying the DoLS appropriately. These safeguards protect the rights of adults using care home services by ensuring that if there are restrictions on their freedom and liberty these are assessed by professionals who are trained to assess whether the restriction is needed. We saw that staff were provided with training on MCA and DoLS. However not all staff we spoke with were confident in their understanding about the MCA and DoLS. We found that the service was not always acting promptly to protect people’s rights. Improvements were needed to ensure staff understood how to protect people’s rights appropriately.

Overall we observed staff interacting with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff were skilled at responding to people’s non-verbal requests promptly and had a good understanding of people’s individual care and support needs. However not all staff treated people in a dignified manner. Improvements were needed to ensure staff understood fully how to respect people’s dignity and to gain consent before undertaking a task or carrying out care.

We found that effective systems were in place to ensure that there were sufficient numbers of suitable staff employed at the service. Staff were provided with training, supervision and opportunities for professional development.

People were supported to be able to eat and drink sufficient amounts to meet their needs. People told us they liked the food and were provided with a variety of meals including both hot and cold options. We found that people were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

We looked at people's care records. The records seen showed that care and treatment was planned and delivered to ensure people's safety and welfare. Information in the records provided clear guidance to staff on how to meet people’s individual needs and promote their independence.

People were supported to maintain their health and well-being. They attended appointments with other healthcare professionals such as opticians, physiotherapists, dentists and chiropodists.

People told us they knew who to speak to if they wanted to raise a concern or make a complaint. We saw that there were processes in place for responding to complaints. People we spoke with told us they were happy with the service and had not had to make a complaint.

The manager and provider regularly assessed and monitored the quality of the care at the home. Appropriate and prompt action was taken to make improvements when required

At our inspection undertaken in April 2013 we found that people were not protected against the risks of unsafe or inappropriate care and treatment as records about them and other matters relating to the management of the service were not accurate, up to date and securely stored.

The provider sent us a written plan to tell us the actions they would take to put this right. We visited on 23 July 2013 and looked at a range of records. We found that the actions had been completed and compliance had been achieved. People’s records were securely stored, their care plans had been updated and staff had received supervision.

We spoke with three people using the service and three relatives. People told us they were satisfied with the care and treatment they or their relative received at the service. One person said, “The care is invariably very good as is the food. The girls are nice. They do care for me well.”

People told us they were able to make everyday choices and that these were respected. This included choosing what they wanted to eat or to have only female staff to provide them with personal care.

People told us that staff were readily available to provide support when needed. Staff told us they felt supported and were provided with the training they needed to help them to care properly for people who used the service.

The provider had appropriate arrangements in place to manage medicines.

We found that some records were not fit for purpose or safely stored to protect people’s confidentiality and privacy.

We spoke with five of the 28 people living at Seven Arches Nursing Home at the time of our inspection visit. People we spoke with told us their privacy, dignity and their right to make decisions was respected. One person said, “They always knock and wait as you have to have your privacy. I might be old but you have got to have your bit of decency.” People also told us that their views and preferences were listened to and supported. We also spoke with three relatives during our inspection visit.

People said were satisfied with the care and support they, or their relative, received at Seven Arches. One person said, “[X] is very well cared for here and I know when I am not here that [X] is safe and well cared for.” People had opportunity to experience meaningful occupation and social activities. Those we spoke with told us they enjoyed the available range of activities and they could choose whether or not to join in.

People told us they felt safe living at Seven Arches Nursing Home and that they would feel able to tell somebody in the home if they were worried or concerned about anything. One person said, "I could say if I was worried, the staff are all very nice. I have never felt uneasy here and they would do anything you wanted if they could."

People found the premises to be comfortable and met their needs. One person said, "My room is really nice and I have some of my own things. I have my own toilet and everything I need. The place is always clean. We have nice gardens and we do use them in the summer."

People who use the service and their relatives were asked for their views about the care at Seven Arches and they were acted upon. This was undertaken through an annual survey. One person using the service said, “You won’t find anything wrong or out of place here.”