.The inspection took place on 3 and 11 January 2018.

Somerset Villa provides accommodation, support and care for up to 16 older people, some of whom are living with dementia. People in care homes receive accommodation and 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. At the time of our inspection 14 people were using the service.

There was a registered manager in place. 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.

At our last inspection of this service on 17 May 2017 we rated the service Inadequate and placed it into special measures because we had some serious concern relating to the staffing levels and staff training, recruitment practices, management of risk and of medicines, consent, nutrition, complaints and overall governance of the service. We issued requirement notices for all these breaches of regulation. Since that inspection the service has been acquired by a new owner and a new registered manager has been appointed. The new owner and management team provided us with action plans showing us how they would make the required improvements. They kept us regularly updated on the progress of these action plans. At this inspection we found improvements in all the areas we had previously been concerned about. It was clear to us that a great deal of hard work had been carried out by the new owner of the business and the registered manager. This had brought about some significant improvements at the service and further improvements were planned.

People who used the service and relatives were happy with the care provided and all praised the way the new provider had made positive changes to the safety and quality of the service.

People received safe care. The registered manager assessed and managed risks well. People were supported to be as independent as possible and involved in their local community. Any associated risks were incorporated into their care plan.

Medicines were mostly well managed and people received their prescribed medicines on time. Occasional stocktaking errors meant we could not be fully assured that all medicines were being given as prescribed. The registered manager took prompt action to address the issue and planned to provide staff with further training and support.

Staff understood their responsibilities with regard to keeping people safe from the risk of abuse. Staff were confident and knew how to raise concerns. Individual safeguarding incidents were well managed and the provider was open and transparent when carrying out safeguarding investigations.

Infection control procedures were in place and staff demonstrated a good knowledge of how to reduce the risk and spread of infection.

Staff were trained to carry out their roles and felt supported. A structured system of induction, training, supervision and appraisal had been set up since the last inspection and was welcomed by staff.

People’s needs related to eating and drinking were managed well and records were good. Staff demonstrated a good knowledge of people’s particular needs in this area, although choice could have been improved.

People had good and prompt access to healthcare and staff worked well with other healthcare professionals to meet people’s needs in this area. Healthcare records had been reviewed and were now electronic, which meant information was more easily shared with relevant health professionals.

The service mostly worked in line with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to care and treatment is assessed. If people

The inspection took place on 17 May 2017 and was unannounced.

The service provides care for up to 16 people, some of whom are living with dementia. At the time of our inspection 14 people were using the service.

We carried out this inspection after concerns were shared with us about the staffing and management of the service. This comprehensive inspection followed up our previous inspection on 10 May 2016. At that inspection we identified two breaches of regulation related to the staffing and management of the service. We rated the service Requires Improvement and the provider submitted an action plan setting out how they would address the shortfalls we identified..

At this inspection we checked to see if the actions had all been completed and found that they had not. We continue to have concerns about the operation of this service.

Since our last inspection a new provider had been identified to buy the business and at the time of our inspection this sale was going through and has since completed. This report relates to Reminiscence Care Limited, which remains the current registered provider.

A registered manager was in post and was also the owner of the business. This provider was intending to remain in post for a period of months following the purchase of the business. 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.

At this inspection we continued to have serious concerns regarding the safety of the service and the management of risk. We found poor practice with regard to the risks fire posed in particular. Fire exits could not be easily accessed and staff were not clear about fire procedures. Safety checks were routinely carried out as required, but risks were not assessed in detail and actions put in place to reduce them.

Medicines were not managed safely as stocktaking procedures were not accurate. This resulted in confusion and an inability to be certain that people had always received their medicines as prescribed. Some medicines were being routinely used to manage people’s behaviour rather than employing techniques to distract and calm them.

Staffing levels had improved since our last inspection and were found to be generally satisfactory. Staff were very busy and this made their approach task focussed at times. Agency staff were frequently used which concerned relatives due to the lack of continuity. Recruitment procedures were not always sufficiently robust.

Most staff received training in safeguarding people from abuse and staff demonstrated a good understanding of action to take if they suspected abuse had taken place.

Staff received training but it was not up to date for all staff. Some key training which would have increased their skills and knowledge had not been provided. Staff did not receive appropriate induction, supervision and support.

The provider was not always operating in accordance with the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA ensures that people’s capacity to consent to their care and treatment is assessed. If people do not have capacity to consent for themselves the appropriate professionals, relatives or legal representatives should be involved to ensure that any decisions are taken in people’s best interests according to a structured process. DoLS ensure that people are not unlawfully deprived of their liberty and where restrictions are required to protect people and keep them safe, this is done in line with legislation.

The provider had failed to ensure the required process was followed with regard to some important decisions about people’s care and treatment. All people who used the service were effectively being deprived of their liberty due to a sy

This inspection took place on 10 and 12 May 2016 and was unannounced.

The home had 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.

Somerset Villa provides accommodation and personal care for up to 16 older people, some of whom may be living with dementia. On the day of our visit, there were 13 people living at the home.

At this inspection we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

The staff knew how to support people to make day to day decisions about their care. However, the principles of the Mental Capacity Act had not always been followed when some decisions had been made on behalf of people. Some people were being deprived of their liberty without the required Deprivation of Liberty Safeguards (DoLS) authorisations being applied for. We asked the registered manager to take action regarding this.

There were enough staff on duty to keep people safe, however there was not enough staff on duty to provide activities or respond to people’s needs in a timely way. Some people had to wait for to receive the care they needed. People were provided with support to eat and drink, mobilise and for personal care.

Staff were kind and friendly towards people living at the home, people responded warmly to staff and relationships were positive. Visitors were welcomed in to the home and appeared at ease.

Some staff had received training on how to provide people with safe and effective care, but there were significant gaps in all staff being trained, or receiving updated or refresher training. Assessment of staff’s competency had only been carried out informally and this was not documented. Improvements were needed to ensure staff understood their role in recognising potential harm or abuse and in protecting people.

People received their medicines when they needed them, but these were not always stored appropriately. There were some minor discrepancies in the records of the administration of medicines.

Improvements were needed to ensure staff had regular supervision and support in order to reflect on their practice and develop their skills. Appropriate pre-employment checks had been carried out for new members of staff.

People were happy with the food provided and were able to make choices about what they wanted to eat. Advice had been sought where people had dietary requirements.

The environment was not fully designed to promote people’s independence and was not suitable for people living with dementia. The environment was in need of refurbishment

The registered manager ensured that people had access to appropriate healthcare. People were able to see a GP when they needed to and access support from community healthcare professionals.

People were not actively involved in planning their care, and plans lacked personal information about choice, routines and interests although staff had an understanding of these. Risks to people had been identified and assessed to reduce and mitigate potential harm.

There was not enough for people to do to occupy them. There was no planning of activities, these were limited to watching television or reading a newspaper. People were bored.

The governance systems in place were not effective at assessing and identifying improvements that were needed to the quality and safety of the care that was being provided. Areas that had been identified as requiring improvement, such as the provision of activities, had not been addressed.

A single inspector for adult social care carried out this inspection. The focus of the inspection was to answer the five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found. The summary describes what people using the service, relatives and staff told us, what we observed and the records we looked at. If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

Records we looked at showed us that risk assessments were completed where a risk had been identified. Measures were described and in place to reduce or eliminate such risks. Requirements under the Mental Capacity Act 2005 including deprivation of liberty (DoLS) were recognised and recorded. Staff explained that they undertook regular training and we saw a list of dates when the staff refresher training was due to be updated. This showed that people were supported by members of staff who knew how to provide support in a safe and appropriate way

Records showed that equipment such as hoists had been regularly serviced and fire checks had been completed on extinguishers. This supported the safety of people who lived at the service, as well as the safety of visitors and staff.

Is the service effective?

Our observations showed us that people who lived at the service were relaxed and confident when they discussed matters with members of staff. Staff took action when they saw anyone who appeared to be unsure or uncomfortable. One person was objecting to the music being played at lunch time. A member of staff discussed this with the person who voiced their opinion and the music was turned down a little as other people were enjoying listening.

Nutrition was monitored by staff as they watched to see how much each person ate at meal times. We saw staff appropriately encouraging people to eat their meals and regular checks on people's weight was recorded to support the early detection of any problems. Our observations, a review of records plus discussions with the cook, showed us that staff did provide alternative meals that people had requested.

Is the service caring?

Our observations showed us that people living in the service were treated with respect at all times. Staff knew the routines that people had chosen and were aware of their care and support needs. We saw that people were dressed cleanly and appropriately for the weather on the day of our inspection.

Although we spoke with people who lived at the service, not everyone was able to answer our questions. This was because some people lived with dementia. However, our observations showed us that staff spoke with respect and in an appropriate manner when they provided support or care to people in the home.

Is the service responsive?

We saw that people's individual physical needs were being met. People were gently encouraged to decide what they wanted to eat at lunch time. Staff showed people what their food choices were by providing each meal for them to see. We saw that staff allowed time for the individual to fully understand their choices and the options offered to them. This showed us that members of staff supported and involved people and did not rush anyone into a quick decision and responded to all requests.

Is the service well led?

Due to the lack of response from questionnaires that had been sent out previously, the provider had employed an external company to deal with surveys. This had meant that a larger number of people had provided feedback. The results of these surveys had been analysed and figures were on record regarding the quality of the service. However, where any issues had been followed up we found there was very little recording of the action that had been taken.

Records showed that members of staff had recorded what routines they had completed for example areas cleaned within the building or in the kitchen area. The manager completed regular spot checks and audits that covered all areas of the service.

We spoke with three people who used the service and two relatives of people who used the service. Not all of the people who used the service were able to communicate with us. To support our judgements we observed the care delivered throughout our inspection to understand people's experience of care provided by the service.

One person we spoke with told us, “It’s quite good really – I can’t think of things they could do better.” Another person told us, “They are all sociable here and they are very kind.” One person’s relative said, “I’m just happy with everything – nothing could be done better.”

We found that before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. We saw that people’s care and treatment reflected relevant research and guidance.

Medication was obtained, handled and stored correctly. Appropriate arrangements were in place in relation to administering medication.

We found that full consideration had not been given in line with current guidance to provide an environment to meet the needs of people, some of whom were living with dementia.

We found that there were enough qualified, skilled and experienced staff to meet people’s needs. People were made aware of the complaints system and this was provided in a format that met their needs.

Most of the people accommodated in the home were living with dementia and were not able to tell us verbally about their experience of Somerset Villa. During our inspection on 10 April 2012 we spoke with a small number of people who were able to discuss their views. We spent time in the communal areas of the home, observing how staff interacted with people and how care was provided. We also spoke with a visitor to the home.

We heard only positive comments about the service. One of the people we spoke with told us that staff were good at looking after people when they were not well. We saw that people were smiling and relaxed around staff. One person described the staff as, "Obliging and courteous." There were staff in the lounges at all times, which meant they could provide support and reassurance to people as soon as they needed it.

Most of the people who use this service have difficulty understanding and responding to verbal communication. During our visit we were able to hold a conversation with two people. A few others were able to make comments about specific issues, such as the meals, however; most of the information about people's experiences of Somerset Villa was gathered through our observations.

We observed that staff showed respect to people using the service. One person with whom we spoke said, "Staff are respectful and speak nicely to people, there is no animosity." Staff understood people's communication difficulties and found ways to help people make choices and decisions about their everyday lives. They respected people's decisions. For example, one person using the service told us, "I love being by myself and no-one tries to stop me."

Care was provided in a dignified way and with regard to people's abilities. People were not rushed. We noted that people were assisted with their personal care and were well groomed. One person told us that they always received their medicines on time and that staff explained to them what they were for.

People using the service said they liked the food. One person told us, "There is a good variety, enough of it and it is well cooked." We saw that people were given the right amount of help to eat their meals.

We saw that people benefited from a clean and pleasant environment. One person told us that their bedroom was always clean and warm.

On the day of our visit we saw that there were enough staff to give people the help they needed. Staff had some time to sit and talk with people in the lounge and to organise a game for a small group. One person using the service told us there was always a member of staff available to take her out.