This inspection was carried out on 27 March 2018 and was unannounced. At their last inspection on 9 May 2017, the provider was found to not be meeting the standards we inspected. At this inspection we found that although they had made some improvements there were some areas that required further improvement and continued to not meet all the standards.

Sloe Hill Residential Home 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. The service accommodates up to 28 people in four adapted buildings. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

With effect from April 2015 providers who have been awarded CQC ratings must display them in each and every premises where a regulated activity is delivered, in their main place of business and on their website.

Ratings must be displayed legibly and conspicuously so that the public, and the people who use the services, can see them. We found that the rating on the provider’s website had been displayed in a way that may be misleading to the public.

There were systems in place to monitor the quality of the home. The management team had embraced monitoring systems and were working on ways to develop them further. However, these systems had not resolved all the issues found on inspection.

People had their individual risks assessed. However, these were not always reflective of changes in people’s needs. Staff knew how to recognise and report any risks to people’s safety, this included fire safety. People’s medicines were managed safely.

People and staff were positive about the running of the home, the registered manager and the provider. There was a complaint’s process which people and their relatives knew how to use. People and their relatives were confident that they would receive feedback from the registered manager.

There was sufficient staff to meet people’s needs, however, staff had not always been recruited safely.

People were supported by staff who had received updates to their training and who felt supported.

Most people were supported in accordance with the principles of the Mental Capacity Act 2005, however, for one person the process had not been followed robustly.

People were addressed by staff with respect and kindness. People’s privacy and dignity was always promoted and confidentiality was promoted.

People received care in a person centred way although activities provided could be further developed to reflect people’s individual hobbies and interests. People and their relatives were involved in planning their care but they did not always take part in reviews of their care. People gave us mixed views about the food but we noted the mealtime experience was pleasant. People had regular access to health care professionals.

This inspection was carried out on 9 May 2017 and was unannounced. At their last inspection on 14 October 2016, they were found to not be meeting the standards we inspected. At this inspection we found that they were not meeting the standards, and there were areas that required improvement.

Sloe Hill Residential Home provides accommodation for up to 28 older people, including people living with dementia. The home is not registered to provide nursing care. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People felt safe, however, staff knowledge in relation to reporting concerns externally needed development. We also found that staff knowledge in relation to fire safety needed further development. Storage of gloves, aprons, continence products and cleaning of commode pots was also an area that required improvement. Although the rating awarded at their last inspection was displayed on their website, it was not displayed in the home.

Individual risks were assessed and staff worked in accordance with the assessments. People’s medicines were managed appropriately. People told us there were enough staff and these were recruited safely.

People were supported by staff who were sufficiently trained and felt supported. The service worked in accordance with the principles of the Mental Capacity Act 2005. People received a varied and balanced diet and there was regular access to health and social care professionals.

People were treated with dignity and respect. People were involved in their care and preferences were promoted. Confidentiality had improved, however records needed to consistently stored securely.

People received care that met their needs and their care plans were detailed and person centred. Activities were provided but these needed further development. People knew how to make a complaint but there had not been any recent complaints. People, their relatives and staff were positive about the management team. Systems had been developed to help monitor the quality of the service.

This inspection was carried out on 11 and 14 October 2016 and was unannounced. At their last inspection on 10 November 2015, although they were found to be meeting all the standards we inspected, we found there were areas that required improvement. This was in relation to the management systems in the home and medicine records. We found at this inspection that they had not made the required improvements. At this inspection we found breaches in relation to safeguarding people from abuse, consent, management systems and staffing. We also found breaches in relation to the registration requirements.

Sloe Hill is registered to provide accommodation for up to 28 people. The home provides support with personal care for older people, some of whom live with dementia. At the time of the inspection there were 24 people living there.

The service had a manager who was registered with the Care Quality Commission (CQC). A registered manager is a person who has registered with the 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.

People told us they felt safe. People’s medicines were administered as prescribed but records and systems required improvement. Accidents and incidents were not analysed to help identify themes and trends. We also found if a person sustained an unexplained bruise or skin tear, these were not investigated or reported. In addition, staff knowledge in regards to safeguarding people from abuse needed development. We also found that some of the principles of MCA and DoLS were not followed.

The systems in place to monitor the quality of the service and address any shortfalls was not consistently effective and staff did not feel listened to. We also found that they had not displayed the awarded rating accurately on their website and it was not displayed in the service in accordance with the rating they had been given. However, people and their relatives were positive about the service and the management team.

People told us they were supported by enough staff who were knowledgeable, but they were busy. However, this needed to be reviewed using an appropriate dependency tool. Staff told us that they felt staffing at the service was an issue. They also felt they did not receive enough training. The appropriate recruitment checks were carried out.

People had a healthy and balanced diet and there was regular access to healthcare professionals. People and relatives told us staff were kind and that they were involved in the planning of their care. Although we found staff were discreet and respectful, care plans were not always held securely.

People received care that met their needs and had care plans in place. There were activities and outings available that people enjoyed. Complaints were investigated but the process needed further development to ensure all feedback to complainants was captured.

This inspection was carried out on 10 November 2015 and was unannounced.

Sloe Hill is a residential care home that provides accommodation and personal care for up to 28 older people, some of whom live with dementia. At the time of our inspection there were 21 people living at 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. 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.

At our previous inspection on 02 May 2014 we found them to be meeting the required standards. At this inspection we found that they had continued to meet the standards. People’s safety was promoted by staff who knew them well and were able to mitigate risks to people`s wellbeing. However there were not sufficient risk assessment recorded and plans available in care plans to ensure people were safe at all times. Care plans were not consistent in layout and information about people; they had no assessments to establish if a person was or not at risk of malnutrition (MUST) or risk of developing pressure ulcers (Waterlow).

People, their relatives and staff were very positive about the manager and the provider who was involved in the home and had established good relationships with them. There were systems in place to monitor and improve the quality of the service. However, these were not recorded consistently to provide an audit trail of the improvements made and the areas checked.

Staff were trained to recognise and report any signs of possible abuse. They were confident to tell us when and how they would report to managers or outside the home to local safeguarding authorities or the Care Quality Commission (CQC). People were cared for by staff who were knowledgeable about people`s needs and they provided care in a kind and respectful manner.

People were offered a choice of nutritious food in accordance with their needs and preferences. People had access to activities that complemented their interests and hobbies. However, some people felt the activities were not stimulating enough for them and they chose not to participate.

People were supported by the staff to attend hospital appointments and to have access to health care professionals when there was a need for it. Health and social care professionals were very positive about the staff team at Sloe Hill and the service they provided.

We checked whether the service was working in line with the principles of The Mental Capacity Act (2005) (MCA). We found that people had their mental capacity assessed and if they lacked capacity the manager had submitted Deprivation of Liberty Safeguards (DoLS) applications to the Local Authority. The manager and staff were familiar with their role in relation to MCA and DoLS.

We consider all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This is a summary of what we found.

Is the service safe?

People had been cared for in an environment that was safe. People’s care plans reflected their individual needs and regular reviews and staff hand overs ensured good safe care. One person said, “I definitely feel safe, oh yes I get good care.”

Is the service effective?

People told us that they were happy with the care that had been delivered and their needs were being met. It was clear from our observations and from speaking with staff that they had a good understanding of the people’s care and support needs. “One person who used the service said, “I am happy here, very good, very helpful, very cheerful. They [staff] are excellent.”

Is the service caring?

People were supported by kind attentive staff. We saw that staff were thoughtful and caring. They spoke to people in a polite and respectful way. We observed good interaction between staff and people who used the service. One relative we spoke with said, “I know my [Name] is safe. When I leave I don’t have to worry because she is cared for well.” One person said, “Staff are very helpful, couldn’t wish for better help.”

Is the service responsive?

All people who used the service had pre-admission assessments undertaken to ensure the home could meet their needs. Their care plans were regularly reviewed and people’s needs were assessed and documented, all care plans we saw had a named key worker. There were lots of activities for people.

At a resident’s meeting, it was noted that plates were not warmed before serving the food. This had now been resolved; the kitchen now used a hot plate. One person said, “I was asked by the provider was everything ok, I told him that it was except I didn’t like the sausages they used. The provider has changed them for me.”

Is the service well led?

Staff were well led and up to date with their training, there were quality assurance processes in place. People’s views were sought verbally, there were monthly resident and staff meetings and yearly surveys were sent to residents, families and advocates. People and relatives we spoke with confirmed they could talk to staff and management.

The person identified as the registered manager at the front of this report was not managing the service at the time of our inspection.

When we inspected Sloe Hill Residential Home on 09 October 2013 we saw that people were routinely asked for their consent about their every-day care and treatment and the staff acted in accordance with their wishes. We saw numerous examples during our inspection of such consent being sought through every-day conversation.

The provider did not have suitable arrangements in place to obtain the consent of people living at the home in relation to 'Do not attempt cardio-pulmonary resuscitation' (DNACPR) decisions.

We found that people’s needs were assessed and care and treatment was planned and delivered in line with those individual needs. People's care plans were reviewed every month which meant that people's needs and support arrangements were up to date. One person living at the home said, “It’s really nice. Everyone is lovely. They really look after you well.” The relatives of one person told us, “My [relative] has always been well cared for here. They know [my relative] so well now and they always know exactly what [my relative] needs.”

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines. People's medicine records were accurate and reflected their medication care plans. One person confirmed that they always received their medication on time and in the correct amount.

We found that there were enough staff to meet people’s needs. One person said, “They are always around if you need them.”

People's records were stored securely. However, some of the records were not accurate. There were no end-of-life care plans for people who were subject to DNACPR decisions and there were some gaps in the repositioning charts of two people at risk of pressure ulcers.

We spoke with people living at this home as well as visitors who told us about their relative's experience. People told us they were involved in decisions about their care and about the way the home was run. They also told us that they had plenty of opportunity to make choices, for example, about what they ate.

People said their dignity was preserved and their privacy was respected. One person said, "They always knock and wait to come in when they need to come into my room". People also told us about a visiting minister and a visiting priest who came in to the home to ensure people's spiritual and faith needs were met.

People's relatives told us that they could advocate for their relatives, especially when they were unwell. They also said that they were pleased with the way the staff at the home helped people to celebrate their birthdays.

One person told us, "We are very lucky to live here; we get looked after exceptionally well." People also told us that there were a range of activities organised that catered for everyone's needs and ensured that every person living there had the opportunity to be involved or not as they wished. These activities included regular outings, group activities and 'memories' discussions where people were encouraged to share their reminiscences.

People we spoke with said they felt the home was a safe place to live. One person said, "I feel very safe here." Another person told us, "All the people that work here they are very kind and considerate." People also spoke very well of the staff and one visitor said, "The staff here are lovely, really friendly and they all seem to get on well together."