About the service: Snapethorpe Hall is a residential care home that was providing personal and nursing care to 41 people aged 65 and over at the time of the inspection.

People’s experience of using this service:

¿ The service has been without a registered manager and stable leadership since August 2018. This has impacted on the quality of service people have received.

¿ Staff told us the new manager was flexible and approachable. One staff member said, “[Manager] is really good and she’s supported the staff.” Another staff member told us, “It’s the best it’s been now. We’ve got [manager] here.”

¿ Most people told us they felt safe living at Snapethorpe Hall. Comments included, “I feel safe I have no worries. “I feel safe and my room is well clean.”

¿ At the last inspection we made a recommendation that the provider assessed how staff were deployed at mealtimes, particularly on the nursing unit. At the time of inspection this had not been completed.

¿ Throughout inspection we found call bells were not responded to in a timely manner on the residential and nursing units. One person told us, “When I ring my buzzer, they’re busy busy busy. It depends how long before they come.” Another person said, “It is normally around 5 to 10 minutes to come for the buzzer.”

¿ People were involved in making decisions about their care. We saw input from people and their families in reviews. However, people gave mixed feedback about the quality of care they received. One person said, “They [staff] do their best.” and “The staff are very kind and they understand me.”

¿ Another person commented, “I don’t feel well looked after. People leave and new people come and they don’t understand what to do.”

¿ We found people's risks were not always adequately assessed. We concluded this was a breach of regulation 12 of the Health and Social Care Act (Regulated Activities) Regulations 2014, safe care and treatment. .

¿ At the time of inspection, the manager, with a care review team, had begun to ensure all care plans and risk assessments were up to date and specific to people’s needs.

¿ Staff recruitment records demonstrated the service was ensuring staff were subject to the appropriate scrutiny.

¿ Medicines were managed safely.

¿ The service was working within the principles of the Mental Capacity Act 2005. People had clear decision specific capacity assessments, including best interest decisions which involved all relevant people.

¿ Staff received appropriate training. The manager had identified there were gaps in monitoring people’s induction and would be retrospectively looking at this to ensure all new staff had received a thorough induction.

¿ People were provided with a choice of food and drinks which met their needs and preferences.

¿ People’s dignity was not always promoted. One person was not supported to use a commode or toilet despite them wanting to. The service had received a similar complaint regarding another person on the nursing unit in August 2018. We found this to be a breach of regulation 10 of the Health and Social Care Act (Regulated Activities) Regulations 2014, dignity and respect.

¿ The provider had a complaints policy and procedure in place. The manager kept an overview of complaints in order to identify any patterns and trends. We saw complaints were investigated and dealt with appropriately.

¿ We found people had generic end of life care plans. These were not sufficiently detailed to show how a person wished their end of life care and support to look like.

¿ The manager completed audits in areas such as, people’s dining experience, care plans, risk assessments, weights, infection control, accidents and incidents, safeguarding and complaints. We saw action points were created as a result of audits and followed up.

¿ The provider had not taken action to address the recommendations made at the last CQC inspection in June 2017. The provider's quality assurance systems had not prevented or addressed the issues found on inspe

The inspection took place on 5 June 2017 and was unannounced. Snapethorpe Hall provides personal care and nursing care for up to 62 older people, some of whom are living with dementia. Accommodation is provided on two floors with lift access between floors. Communal lounge and dining areas are provided on both floors. On the day we inspected there were 51 people living at the home; 15 people were in the specialist dementia unit, 15 people in the residential unit and 21 in the nursing area.

There was a registered manager in post. 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 2008 and associated Regulations about how the service is run.

We had previously inspected the home in April 2016. At the previous inspection, we found staff did not have access to written instructions for the safe moving and handling of people. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also found there was no consistent recording or understanding about people's ability to consent to care. This was a breach of Regulation 11 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

During this inspection we checked whether there had been any improvement in the service. We found there had been and the provider was no longer in breach of the regulations.

We saw safeguarding matters and accidents and incidents were responded to appropriately. We checked staff files and found all recruitment checks had been carried out as required. Staff felt supported and had regular training and supervision.

We checked staff rotas and saw all shifts had been covered up to two weeks in advance where gaps had been identified, particularly in the nursing staff. We observed call bells were responded to in a timely manner. We observed a number of people who needed assistance to eat would have had to wait some time if relatives had not been available. We recommend that the provider assesses the staffing levels around mealtimes.

We saw systems were in place for the ordering, recording and disposal of all medicines received into the home. Medication Administration Record sheets (MARs) were completed with the detail and the amount of the medicine received. We were concerned medicines which needed to be taken before food were not always administered in line with the manufacturer’s instructions. The registered manager rectified this issue on the day of inspection.

Staff understood the basic principles of the Mental Capacity Act (2005). 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.

We observed most bedroom doors in the home were open, although we checked with the people we spoke with and they did confirm this was what they wanted. We recommend that the provider needs to evidence people’s choice to have their bedroom doors open permanently or whether it has become standard practice.

We found people were appropriately supported to eat and drink. People’s weight was monitored, some on a weekly basis where concerns had been identified. People had access other healthcare professionals when required.

The people we spoke with told us staff were caring and friendly. They also told us staff knew them well and understood their needs. People’s independence was promoted well and staff encouraged people to do as much for themselves as they were able.

People’s care records were detailed and person-centred. Care plans were in place for communication, personal care, mobility, eating and drinking, safety, medication, activities, sleeping, continence and skin care.

The provider monitored the quality of the service. Regular audits

The inspection of Snapethorpe Hall took place on 5 April 2016 and was unannounced. We had previously inspected the home in September 2015 and found it to be requiring improvement in all areas apart from responsive which was rated good. At the previous inspection, there were breaches of regulations in regards to dignity and respect displayed by staff, medication errors and a lack of staff. We brought forward this inspection following receipt of concerns around poor staff conduct and unsafe moving and handling practices. During this inspection we checked whether there had been any improvement in the service following receipt of an action plan which detailed how such changes were to be made.

Snapethorpe Hall provides personal care and nursing care for up to 62 older people, some of whom are living with dementia. Accommodation is provided on two floors with lift access between floors. Communal lounge and dining areas are provided on both floors. On the day we inspected there were 48 people living at the home; 12 were in the specialist dementia unit, 14 in the residential area and 22 in the nursing section upstairs in the home. The home had recently changed the nursing unit to upstairs to create a more secure and cosy dementia unit downstairs.

The home had recently appointed a new manager who was undergoing the required checks before being registered. They had been in post since 8 March. 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 living in the home felt safe and had confidence in the staff caring for them. Staff were able to explain what action they would take if they were concerned about someone and knew the procedure to report such concerns.

Some people living in the home did not feel there were enough staff and this was also reflected by some staff comments. We did not witness any major impact on people in the home but were aware that staff were working in a pressured situation for much of the time we were there, and that in the dementia unit some people required one-to-one care which restricted the flexibility of the staff team to respond at times.

Medicines were administered safely although we found issues with the lack of fridge temperature monitoring in the treatment room and for some people, a lack of specific instructions in how they took their medication. There were no specific capacity assessments or best interest decisions detailing how to support someone who was resistant to taking medicines.

Risk assessments were in place for factors such as choking, skin integrity and falls but not all of the risk assessments were detailed and some contained conflicting information. We could not find any reference to safe moving and handling instructions for staff when using equipment such as a hoist. This was a breach of Regulation 12 Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as staff did not have access to written instructions for the safe moving and handling of people.

People in the dementia unit were supported well with their nutrition and hydration needs but this was not reflected in all areas of the home. Food and fluid charts were kept but not always used to their full potential. However, the new manager had implemented further training and detailed care plans in relation to supporting people with weight loss. People had timely access to health and social care services.

Staff had received supervision from the new manager since they had started but there were gaps in the training schedule for some staff. The manager was aware of this and addressing these gaps. It was evident from conversations with staff that understanding around the requirements of the Mental Capacity Act 2005 and its associat

The inspection of Snapethorpe Hall took place on 22 September 2015 and was unannounced. The home had previously been inspected in June 2014 and was compliant in all areas.

Snapethorpe Hall provides personal care and nursing care for up to 62 older people, some of whom are living with a diagnosis of dementia. Accommodation is provided on two floors with lift access between floors. Communal lounge and dining areas are provided on both floors. There were 53 people living in the home on the day of our inspection. The home had three distinct units. On the ground floor there was a general nursing unit known as Southgate and a general residential unit called Northgate. Upstairs the provision was for people living with a diagnosis of dementia which provided both residential and nursing care and this was the Kitwood suite.

There was a registered manager in post on the day of our inspection. 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 living at Snapethope Hall and staff were able to explain symptoms and signs of possible abuse, and knew how to report any concerns. Risk assessments were completed thoroughly and reflected people’s needs.

We found that staff were not always visible and this meant that, at times, people’s needs were not met in a timely manner. We also found significant issues with the administration and recording of medicines.

Staff had access to regular training and were knowledgeable about their role. They had an understanding of the requirements of the Mental Capacity Act 2005 and the associated Deprivation of Liberty Safeguards.

Although people were offered choices in food and drink throughout the day, we observed that some people were not always supported when needed as staff were otherwise occupied.

We found a varied response in terms of staff’s contact with people. Some displayed excellent interpersonal skills but others showed a lack of regard for people as individuals. On one occasion this was challenged by other staff members.

There were various activities available for people, both shared and individual which were provided through the activities co-ordinator. Care records were person-centred and reflected individual needs.

The registered manager took their responsibilities seriously and people and relatives spoke highly of them. However, not all staff felt able to raise issues. There was a robust auditing system in place which showed the home was keen to make improvements.

You can see what action we told the provider to take at the back of the full version of the report.

This was a responsive inspection, which followed up on our last visit in which outcomes 4 (care and welfare), 5 (nutrition), 9 (management of medicines) and 13 (staffing) were non-compliant. The service has four separate units – Northgate, Southgate, Kirkgate and Westgate – and we visited all of them during this inspection. Below is a summary of what we found.

Is the service safe?

We found the systems for managing medications were safe. There were sufficient staff on duty to meet people’s needs safely.

Is the service caring?

We found staff were kind and caring. People received care that was planned and delivered to meet their individual needs.

Is the service effective?

The service had made improvements since the last inspection to ensure people received good care. Staff had a good understanding and knowledge of people’s needs, which meant they were able to provide effective care for them.

Is the service responsive?

We found the service had responded and improved the mealtime experiences for people. Increased staffing levels meant people were receiving the care and support they needed.

Is the service well led?

We found management structures had been strengthened to enable the effective maintenance of staffing levels and staff deployment.

Snapethorpe Hall provides nursing and personal care to people in four separate units. Northgate and Southgate units on the ground floor and Westgate and Kirkgate units on the first floor.

We carried out this inspection in response to concerns raised at recent safeguarding meetings regarding the care provided to people who lived on the Kirkgate and Westgate units. Both units provided care and support to people with dementia. We visited late in the afternoon as concerns had been raised about the staffing levels on these units, particularly over the tea time period. We also reviewed the care provided to people and the management of medicines as concerns had been identified. We focused our visit on the first floor and did not spend time on Northgate and Southgate units at this inspection.

During the inspection we spoke with the Quality Assurance Manager, the registered manager, three relatives, three people who lived in the home and six members of staff. We spent time observing the care being delivered and how staff interacted with people.

We found there were shortfalls in the care records, which meant it was not clear what people’s current needs were or how they were being met. We identified some areas where people’s dignity was not respected. People we spoke with gave mixed views about the care. One person said: “I like it here. The girls are nice”. Another person said: “I’m fed up and so bored. Nothing to do”. A further person told us: “It’s good here, not a lot going on but happy watching telly”.

We observed the tea time meal was disorganised, which meant people were not provided with the support and supervision needed to ensure they received adequate food and fluids. The menu displayed did not reflect the food served and pureed diets were not presented in a way that enabled the person to distinguish the different tastes or textures of the meal.

We found discrepancies in the medicines administration records, which meant we could not determine if some people had received their medicines as prescribed.

We found although the staffing levels may be considered sufficient for the number of people living on the first floor, the layout of the units and the dependency levels of the people accommodated meant more staff were required to ensure people's needs were met at all times.

During our visit we spent time in the nursing and residential units on the ground floor and the dementia unit on the first floor of the home. We spoke with three people who used the service, six relatives, two health care professionals, six staff and the manager. We reviewed five people’s care records and looked at other records and documents relating to the running of the service.

We saw that people were treated with dignity and respect by staff. We saw that staff were caring and kind in their interactions with people and offered them choices in all aspects of their daily lives. People who used the service told us staff were “very good” and relatives said they were satisfied with the care and support provided.

People looked well care for and staff we spoke with had a good understanding of people’s needs. New care documentation was being implemented in the home. We saw evidence that people who used the service and their relatives were involved in planning care.

People told us they enjoyed the food. One person described the food as “brilliant”. We saw that people were offered a choice and nutritional needs were assessed and monitored by staff.

We found the home was clean and well maintained. We were told there is an ongoing refurbishment programme to improve the environment.

We observed that there were sufficient staff to meet people’s needs.

We saw there were systems in place to monitor and audit the quality of service people received.

The people we met who are nursed in bed and who we could not communicate with although very poorly were observed to be warm and comfortable and relaxed.

A positive relationship was observed being fostered between those living in the home and those caring for them and enough staff were observed to be available to meet peoples care needs in a relaxed and unhurried manner.