This inspection took place on 11 June 2018 and was unannounced.

St Marys Care Home was last inspected in September and October 2017 and was rated as Requires Improvement. We rated the key question of ‘Well led’ as Inadequate. At that inspection, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We took enforcement action to impose positive conditions. This meant the provider had to submit records to the Care Quality Commission (CQC), monthly, to demonstrate they were taking actions to rectify and improve the quality of care at the service. The CQC had already issued a warning notice, and placed a condition to restrict admissions to the service at a previous inspection in February 2017. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least Good.

St Mary’s is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. St Mary’s Care Home provides personal care for up to 44 people over one floor. At the time of our inspection, there were 21 people living there. St Mary’s provides personal care to people living with a range of health conditions, including physical disabilities and people living with dementia.

At this inspection we found improvements had been made in all the areas identified at the previous inspection. This meant the service had met all the outstanding legal requirements from the last inspection and is now rated as Good. The key question of Safe continues to be rated as Requires Improvement as although we found improvements had been made, there were still shortfalls in the safe management of medicines.

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

Staff knew how to keep people safe from abuse. Staff were confident that if they had any concerns they would be addressed quickly by the registered manager. Risks to people had been assessed and regularly reviewed. Actions had been taken to mitigate these where necessary. Checks had been made on the environment to ensure the service was safe. Equipment to support people with their mobility, such as hoists had been checked to ensure people were safe.

The management of people’s medicines had improved, however, audits carried out by staff and by the providers quality assurance team had not identified errors in these records. Records of when people had topical medicines applied were not always completed.

There were enough staff to ensure people were safe and had their needs met in a timely way. Staff had the skills and knowledge to carry out their roles and were supported by a system of induction, relevant training, one-to-one supervision and appraisals.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. Staff understood their responsibilities under MCA, people's capacity had been assessed and when required best interest’s meetings had been held and recorded.

People told us that they enjoyed the food. People had a choice of meals and were supported to maintain a healthy diet in line with their choic

The inspection took place on 27 September 2017 and 2 October 2017 and was unannounced.

St Mary’s Care Home provides residential care for up to 44 people, some of whom may be living with dementia. At the time of this inspection there were 34 people living in the home.

Accommodation is over one floor and the home has a number of communal areas available to those living there as well as an accessible garden.

Whilst there was a manager registered with the Care Quality Commission (CQC) to manage this service at the time of this inspection, they were no longer working at the home. 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. There was also no deputy manager in post at the time of this inspection and, on our first inspection visit, a senior care assistant was managing the home. An interim manager was in situ at our second inspection visit.

We last inspected this service in February 2017 where we found the provider had failed to meet the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the February 2017 inspection, we found three breaches to the regulations. These breaches related to safe care and treatment, the need for consent and good governance.

We served requirement notices in relation to the need for consent and good governance. The provider sent us a plan to tell us about the actions they were going to take to rectify these breaches. They told us these would be completed by May 2017. In response to the breach to safe care and treatment, we took enforcement action against the provider in order to help drive improvement. We imposed conditions on their registration in relation to the management of medicines. This meant the provider had to submit records to the CQC, on a monthly basis, to demonstrate they were taking actions to rectify and improve medicines management. These had been submitted as required.

At this inspection, carried out in September and October 2017, we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be in breach of safe care and treatment and good governance. In addition, the service had failed to safeguard people from abuse and improper treatment, to employ fit and proper persons and notify the CQC of reportable events that affect people’s safety.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The provider had failed to have effective systems in place to ensure a consistently caring, effective and safe service had been delivered. This failure had been evident since the provider first breached regulations to the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in September 2014. The provider has been consistently non-compliant since this date and continues to be so.

On our first inspection visit, there was no management team in place to manage the day to day running of the service. The provider had placed the responsibility of this onto a senior care assistant who was also expected to work their normal role. This had put strain on the service particularly as the home was also working with less staff than the provider deemed appropriate to provide a service. At our second inspection visit, an interim manager was in place.

Full information and checks had not been sought on all employed staff in order for the provider to fully assess their suitability to work with those that used the service. This had put those who lived at the service at risk. Furthermore, the provider had failed to fully assess, analyse, manage and mitigate the individual risks to those living at St Mary’s Care Home. This had put them, and others, at risk of harm.

Incidents that had affecte

The inspection took place on 6 and 7 February 2017 and was unannounced.

St Mary’s Care Home provides residential care for up to 44 older people, some of whom may be living with dementia. The home is purpose built and accommodation is on one floor. All rooms, except four, have en-suite facilities. Communal areas include a number of lounges, a dining room and a conservatory. The home has extensive gardens. At the time of our inspection there were 28 people living within the home.

There was a registered manager in post whose application had been processed shortly before the inspection was carried out. 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 inspected this service in April 2016 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Three breaches of legal requirements were found and a warning notice was issued in relation to one of them which involved the governance of the service. The provider sent us a plan to tell us about the actions they were going to take to meet the breaches of the remaining two regulations.

A further inspection was carried out in September 2016. This was a focused inspection to check that the service had undertaken changes to meet the warning notice. We found that sufficient improvements had not been made and that the service was still in breach of the regulation.

At this inspection in February 2017, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to safe care and treatment, the need for consent and good governance. Whilst some improvements had been made, the service continued to be in breach of the regulation relating to safe care and treatment for a third consecutive inspection. The service also continued to be in breach of the regulation involving the governance of the home for the fourth consecutive inspection.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Fully effective systems were not in place to monitor the quality of the service and drive prompt and continued improvement. The system had failed to fully identify and rectify the issues highlighted in this report.

The management and administration of people’s medicines did not fully follow good practice guidance. This meant that we could not be sure that people had received their medicines as the prescriber had intended.

The individual risks to the people who used the service had not always been identified, recorded or managed by the service. This was compounded by gaps in care records that did not effectively demonstrate that people had received the care and support they needed.

The CQC is required to monitor the Mental Capacity Act (MCA) 2005 Deprivation of Liberty Safeguards (DoLS) and report on what we find. People’s human rights had not always been respected and the service had not consistently worked within the principles of the Act. Staff were able to demonstrate that they assisted people to make choices but their knowledge of the MCA was poor.

The service had procedures in place that reduced the risk of employing people not suitable to work in the service. New staff received an induction and all staff received ongoing training. Staff told us that they felt supported in their roles and a supervision plan was in place to ensure staff received these. The registered manager also had a plan in place to complete staff appraisals.

At past inspections, there had not been enough staff to meet people’s needs. At this inspection, improvements had been made

We carried out an unannounced comprehensive inspection of this service on 20 and 21 April 2016. Three breaches of legal requirements were found and a warning notice was issued in relation to one of them which involved the governance of the service. We gave the provider until 20 June 2016 to meet the legal requirements of this regulation.

We undertook this focused inspection to check that the service had undertaken changes to meet the legal requirements of this regulation. This report only covers the findings in relation to the warning notice. You can read the report from our last comprehensive inspection in April 2016, by selecting the 'all reports' link for St Mary’s Care Home on our website at www.cqc.org.uk.

At this inspection carried out on 1 September 2016 we found that there were still considerable concerns in relation to the governance of the home. We have not changed the overall rating for this service as a result of this inspection as it was only undertaken to follow up our enforcement action. The service, and the domain of well-led, remains as requires improvement.

St Mary’s Care Home provides residential care for up to 44 people, some of whom may be living with dementia. At the time of our inspection 36 people were living there. Accommodation is on one floor with a number of communal areas.

At the time of this inspection, the home did not have a registered manager in post and a number of recent changes had occurred in the management of it. 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.

The registered manager had left at the end of July 2016 and an interim manager had been in post. This person had also recently left the service and an acting manager had been appointed the week prior to our inspection. The acting manager had been employed by the provider for approximately five weeks having been originally appointed as a deputy manager at St Mary’s Care Home. During our visit, two registered managers from other homes owned by the provider were present to support the acting manager during the inspection.

At this visit carried out on 1 September 2016 the managers we spoke with could not provide us with all the information we requested. We therefore gave the provider the opportunity to submit any further information in relation to the warning notice up until 5pm the following day. No additional information was submitted.

At the inspection in April 2016, concerns were identified that demonstrated that the provider did not have effective systems in place to monitor the quality and safety of the service delivered. This had resulted in some people receiving a poor service.

At this inspection we saw that although some improvements had been made, the service was still in breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 which relates to governance.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Although some processes were in place to monitor the quality and safety of the service provided, these were not wholly effective. The service had failed to appropriately manage the concerns highlighted in this report. These included a lack of staff to meet people’s needs in a person-centred manner resulting in people having to wait for assistance. Issues in relation to medicines administration and management had not been identified by the service. There was also a lack of clear action plans when it had been identified that the service fell short of the required standard.

Some improvements had been made since our last inspection in April 2016. The service ha

The inspection took place on 20 and 21 April 2016 and was unannounced.

St Mary’s Care Home provides residential care for up to 44 people, some of whom may be living with dementia. Accommodation is on one floor and all rooms, except four, have en-suite facilities. Communal areas include a number of lounges, a dining room, conservatory and extensive gardens. At the time of our inspection, 35 people were living in the home.

The service had 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 of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We last inspected this service on 12 and 17 November 2015 where we found that the service was not meeting the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was in breach of four regulations relating to safe care and treatment, meeting nutritional and hydration needs, staffing and good governance.

Following the inspection in November 2015, the service sent us a plan to tell us about the actions they were going to take to meet the above regulations. They told us these actions would be completed immediately.

At this inspection in April 2016, we found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to staffing levels, medicines management and governance. You can see what action we told the provider to take at the back of the full version of this report.

Although the service had a system in place to monitor and assess the quality of the service, these had not been effective as they had not fully identified the issues highlighted in this report.

The medicine records contained gaps and inconsistencies and so it was not clear whether people had received their medicines as the prescriber had intended. Medicines for external application were not securely stored meaning these could be accessed which put people at potential risk.

People‘s individual needs were not always met in a timely manner and people told us there were not enough staff. People sometimes had to wait for assistance. The service had not consistently provided the amount of staff they had assessed as being required to meet people’s needs.

Staff did not always promote people’s dignity and their independence was not always maintained. However, people had choice in how they spent their day and staff treated them with respect. Staff demonstrated a kind and caring approach when supporting people.

Training had been provided to ensure staff were competent in their roles. Staff told us they received regular support and were encouraged to offer suggestions for improving the quality of the service. However, some staff did not always feel that the service managers listened to them.

People were encouraged to provide feedback on the service and complaints were investigated. However, some people did not feel that their complaints had been listened to appropriately and did not feel confident that it would be addressed effectively. The registered manager had acknowledged this and sought training to improve their skills in this area.

The risks to people, visitors and staff had been identified, assessed and reviewed on a regular basis. Staff understood the processes in place to help protect people from the risk of abuse and knew how to report any concerns they may have. Accidents and incidents had been recorded, fully investigated and actions taken to minimise any future risk of reoccurrence. Recruitment processes were in place to ensure that the risks of employing unsuitable staff were minimised.

People, and where appropriate, their relatives, had been involved in planning the care they received. Care records showed that these were individual to the per

This inspection was unannounced and took place on 10 February 2015. The inspection was carried out by two inspectors.

At our last inspection on 05 September 2014, we asked the provider to make improvements in respect of concerns about the lack of adherence to the Mental Capacity Act (MCA), ensuring that people’s needs were met and also with the staffing levels provided. An action plan telling us how and by when the necessary improvements would be made was completed by the manager. The anticipated outcomes have been considered as part of this inspection.

During this inspection we checked on the home’s improvement plan and found that action had been taken about adherence to the MCA and ensuring people’s needs were met. There was also an increase in the number of staff employed.

The service provides care and accommodation for up to 44 older people some of whom are living with dementia. On the day of this inspection there were 39 people living in this home.

This service is required to have 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. At the time of this inspection the manager had submitted an application to become registered with us.

Staff recognised the signs of abuse and knew what to do if they suspected that abuse was taking place. All staff received refresher training about this each year. There were thorough recruitment practices in place to help protect vulnerable people. Individual risk assessments were in place so that steps could be taken to reduce avoidable harm.

There were enough staff employed to meet people’s needs although there was evidence that they were not deployed effectively so that people’s needs could be met in a timely way. We have asked the manager to review how staff are deployed within the home.

People were protected by safe medication practices, although people were not receiving their medicines at the prescribed times due to the ineffective way that staff were deployed.

People made choices where they were able around daily living. Choices and options were offered to people and staff respected the decisions that people made. Staff spoke kindly and respectfully to people and encouraged them to be as independent as possible.

Staff knew about the Mental Capacity Act and Deprivation of Liberty Safeguards. They were due to receive training about this so that their understanding of this legislation and how it affected the way they supported people in their best interests was improved.

The service had a complaints procedure in place although some relatives felt that they were not listened to when they raised concerns. Some people and relatives also said that they had not been asked for their views about the quality of the service although an annual survey was sent out by the provider.

Audits were in place to ensure that the environment and all care activities and processes within the home were safe and effective.

The manager named at the beginning of this report no longer works at this service. CQC has not yet received a cancellation application for this person and an application to register is awaited from the recently appointed manager.

This inspection was carried out in response to concerns raised with us about low staff numbers at night. We were also told that people were being got up early in the morning whether they wanted to or not. As a result, this inspection commenced at 5:45 a.m. in the morning and was unannounced.

The inspection team who carried out this inspection consisted of two inspectors. The focus of the inspection was to answer four key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive to people’s needs?

Below is a summary of what we found. The summary describes what people using the service, their relatives and the 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.

Is the service safe?

We looked at the staff rotas which showed there were not always sufficient staff on duty to meet people’s needs throughout the day and night. They showed that over the four weeks prior to our visit, there had been 15 occasions when the home was staffed below the level the service deemed necessary overnight. The rotas for during the day also showed that the service was staffed below the level the service deemed necessary on 25 shifts. This meant that people did not receive a consistent and safe level of support.

One person told us, “You ring the bell at lunchtime and you have to wait 20 minutes or half an hour.” Another person said, “Most of the staff are good but there’s not enough of them.” A visitor commented, “I’ve told them there’s not enough staff but they told me they were fully staffed.”

We spoke with the manager about the Deprivation of Liberty Safeguards (DoLS). They told us that they had been in contact with the local authority to enquire about when they could commence making applications. This demonstrated to us that where there were concerns that the appropriate action would be taken.

Is the service effective?

People had an individual care plan which set out their care needs. The care plans we looked at recorded that relatives had been involved in the review process although they had not signed the review forms to demonstrate they agreed with the plans. Night care plans, setting out how people wished to be cared for at night were not in place.

Staff explained how they offered choices to people around the time they got up in the morning and the clothes they wore. Where people were unable to make these choices, staff told us they acted in the best interests of the individual or in accordance with the manager’s instructions. However, we did not find evidence that staff had followed the guidelines of the Mental Capacity Act 2005 in making decisions for these people.

Is the service caring?

People we spoke with told us that most of the staff were good and treated them with care and consideration. Some visitors told us, “We’re satisfied with the care [person] receives.” People appeared well cared for and relaxed.

We observed the interaction between staff and people using the service and their visitors. We saw that staff were polite, respectful and friendly. Plenty of laughter was heard at the pre-lunchtime quiz.

Is the service responsive to people’s needs?

People told us that they often had to wait for help and support from staff. One person described how it often took staff 20 minutes to half an hour for staff to respond to their call bell. Visitors also spoke about waiting long periods for staff to respond when they rang the bell on behalf of their relative. During our visit we were aware that call bells were ringing almost continuously from the time of our arrival until just before lunchtime.

During the extended absence of the registered manager, an experienced manager from another of the provider’s homes was spending time at St Mary’s Care Home, providing support and dealing with management issues.

We reviewed the evidence we had obtained during our inspection and used this to answer five key questions we always ask: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well lead?

This is a summary of our findings. If you would like to see the evidence supporting this summary please read the full report.

Is the service safe?

People told us they felt safe and that they were treated with respect by staff. The service was clean and hygienic and there was a cleaning schedule in place to keep the home fresh. One person told us, "It's all very good and I really do mean that."

There were sufficient numbers of qualified, skilled and experienced staff on duty. Staff training was up to date and was relevant to the needs of the people living at St Mary's. This helped to ensure that people's needs were met.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one.

Is the service effective?

The service was introducing new care plan documents and these showed that people's health care needs were assessed. Health and risk assessments identified individual care needs. People told us they were supported to be as independent as possible. One person said, "Staff help me to get up in the morning, then I see to myself."

Visitors told us they could see their relative whenever they wished and that staff always made them welcome. One visitor spoke about how their relative had told a member of staff they felt hungry and the member of staff had brought them some food to eat to see them through until the next mealtime.

Is the service caring?

People told us they liked living at St Mary's and that staff were kind and caring. One person told us, "The staff are kind and attentive." Another person said, "They treat me with respect and speak to me nicely." A visitor to the home told us, "I can't fault them. Just ask and they'll do."

People were supported by kind and attentive staff. We saw that care workers were warm, friendly and respectful and that they offered choices and encouragement to people. Staff had received training that was relevant to their role.

People told us they could spend their day where and with whom they pleased and staff assisted them to do this. One person spoke about preferring to spend time in their room although they had enjoyed attending an activity during the morning.

Is the service responsive?

People were able to access a variety of activities at the service. These included group and one-to-one activities and also outside entertainments. Staff understood the diverse needs and preferences of the people living at the home and how they could be met. Residents' and relatives' meetings were held regularly to seek the views of people using the service.

People knew how to make a complaint if they were unhappy. The complaints process was displayed in the entrance hall. People and visitors were asked to complete annual questionnaires about the quality of the service. The results of these questionnaires were used to develop an action plan for improvement.

People's needs were assessed with reviews taking place on a monthly basis. Where changes occurred the service referred to health professionals for advice and guidance whenever necessary. A visiting health professional confirmed that the service referred to them appropriately and in a timely way.

Is the service well lead?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. They had a good understanding of the ethos of the home, although there was some uncertainty due to the absence of the registered manager.

The service had a quality audit system in place and records seen by us showed that identified shortfalls were addressed. As a result, the quality of the service was continually improving. Audits of the environment were taking place regularly and these records were up-to-date and showed remedial action had been taken where shortfalls were identified.

All of our observations showed staff treating people with respect and speaking to them in a friendly manner, with a good level of interaction. We heard people being asked if they wanted to join the bingo session in the lounge that afternoon. One person, sitting in the conservatory replied: "No thank you, I'd rather read my book."

One person we spoke with had just finished having lunch in their room, which they said was where they preferred to have it. This person also smiled and nodded when we asked if they had enjoyed their lunch that day.

We noted significant improvements to the atmosphere, environment and care provision in St Mary's since our previous inspection in January 2013. Overall, we noticed that there were more people choosing to spend time in various communal areas during this inspection and the whole atmosphere was relaxed, calm and cheerful.

We noted various feedback from people living in the home, expressing their pleasure with some of the environmental improvements, with comments such as: "…love the new hairdressing room and the hairdresser!"

Because some of the people using the service had complex needs, this meant they weren't able to tell us specifically about their experience of living in St Mary's.

However, one person we spoke with said that the staff were very good and another person showed us that they had just had their nails polished by a member of staff, which they said they were very pleased with.

We met and spoke with a person who had recently moved into the home and a family member. Both people said they were very impressed by the food, especially the home-made sponge. The person who had recently moved in told us that they were, "Very happy and settling in well". They also said that the manager and staff were very friendly and helpful.

The person's relative told us that they lived locally and had never heard a bad word spoken about St Mary's. They went on to say that they had been instantly impressed when they came to look around and that the staff had taken time to get to know their relative's needs and preferences.

We gathered further evidence of people’s experiences of the service by carrying out observations and reviewing the information contained in care records.

The majority of our observations showed staff treating people with respect and speaking to them in a friendly manner. However, we saw that, particularly for people with higher levels of need and limited communication, staff sometimes carried out tasks and provided support with little to no interaction.

We met with one person who said that they hadn't wanted to come to St Mary's because they didn't want to leave their own home but, after a few days, they said it was lovely and that they were quite happy to stay there now.

Another person we spoke with told us that the staff were all very good and very kind, although they said it would be nice to have a bit more company at times, as they weren't able 'to get out and about as often as some of the others'.

One person we spoke with told us that they could tell the staff or the manager if they had a problem with anything and that the staff were all 'easy to talk to and very kind and friendly'.

This inspection took place on 12 and 17 November 2015. The inspection began at 4.30am and was unannounced. We had received information of concern that people were being assisted out of bed very early in the morning.

St Mary’s Care Home provides care and support for up to 44 older people, some of whom may be living with dementia. The home is on one level and purpose built. At the time of our inspection there were 37 people living there.

The service had 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 2008 and associated Regulations about how the service is run.

At our last inspection on 10 February 2015 we found the service to be in breach of one legal requirement. We had identified that people’s needs were not met in a timely way due to the poor deployment of staff. After the inspection the provider wrote to us to tell us what they would do to meet the legal requirements. The provider also told us when they were going to complete these actions.

During the inspection on 12 and 17 November 2015 we found the service had increased their staffing levels at peak times. However, improvements were still needed. People were, at times, still waiting too long for assistance.

At this inspection evidence showed four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider had failed to make proper assessments of people’s needs and provide staff with the guidance required to support people safely. The nutritional needs of people with swallowing difficulties were not consistently met and the service was not effective in working with healthcare professionals. The service’s quality auditing system failed to identify and mitigate risks to people’s health and safety.

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

People were supported by staff who had undergone recruitment checks to ensure they were safe to work in care. However, staff had not consistently received the induction, training and competency checks required to ensure they were skilled in their roles. Although not all staff had received up to date training in safeguarding people, they demonstrated they understood how to protect people from harm. People received their medication as prescribed.

The service had used a dependency tool to calculate staffing levels and the amount of staff the tool dictated were in place. However, people told us they had to wait for assistance and that call bell response times were sometimes poor. There were not consistently enough staff available to meet people’s individual needs in a timely way.

Although people had access to healthcare professionals, the service had not ensured that people’s health and nutritional needs were reliably met. Recommendations from professionals were not always followed putting people at risk.

The Care Quality Commission (CQC) is required to monitor the Mental Capacity Act 2005 (MCA) Deprivation of Liberty Safeguards (DoLS) and report on what we find. Staff had a good understanding about people’s capacity to consent to care but lacked knowledge of the MCA DoLS. The service had failed to make timely applications to the local authority in order to protect people’s human rights.

People and their relatives, where appropriate, were involved in the planning of the care and support they required and these needs were reviewed regularly. However, the information the care plans contained was not always accurate and this put people at risk in relation to their health, welfare and safety.

Staff were respectful towards the people they supported and people told us they felt cared for. Staff understood the importance of people making choices about how they spent their day however staff were not always available to meet those individual needs. People’s privacy was maintained but their dignity was sometimes compromised. Staff did not always have a full understanding of the needs of the people they supported.

People benefited from activities taking place but told us they would like more trips out of the home. The service told us they had plans to develop the activities programme to include this.

The home encouraged feedback from people on the quality of the service provided but did not always use this information to improve and develop. Although the home had a number of quality monitoring audits in place, these had failed to identify issues within the service.